Provider Demographics
NPI:1306448394
Name:NORTHWEST ALABAMA PSYCHIATRIC SERVICES
Entity type:Organization
Organization Name:NORTHWEST ALABAMA PSYCHIATRIC SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-384-0141
Mailing Address - Street 1:20 MEDICAL CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3428
Mailing Address - Country:US
Mailing Address - Phone:205-384-0141
Mailing Address - Fax:205-384-0171
Practice Address - Street 1:20 MEDICAL CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3428
Practice Address - Country:US
Practice Address - Phone:205-384-0141
Practice Address - Fax:205-384-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty