Provider Demographics
NPI:1124656657
Name:REDDIX, DARLENE C
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:C
Last Name:REDDIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-5126
Mailing Address - Country:US
Mailing Address - Phone:251-455-9334
Mailing Address - Fax:
Practice Address - Street 1:301 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-5126
Practice Address - Country:US
Practice Address - Phone:251-455-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4044726172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver