Provider Demographics
NPI:1386971257
Name:GURR, JONATHAN WALLACE (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WALLACE
Last Name:GURR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1359 OLD WATER WORKS RD SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3347
Mailing Address - Country:US
Mailing Address - Phone:256-997-5900
Mailing Address - Fax:256-997-5995
Practice Address - Street 1:23800 JOHN T. REID PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35769
Practice Address - Country:US
Practice Address - Phone:256-997-5900
Practice Address - Fax:256-997-5995
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD. 35327208000000X
GA76726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics