Provider Demographics
NPI:1720350473
Name:EUTAW MEDICAL CENTER
Entity type:Organization
Organization Name:EUTAW MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHALANDA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:CABBIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:205-535-6195
Mailing Address - Street 1:2109 41ST CT NE
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-1511
Mailing Address - Country:US
Mailing Address - Phone:205-535-6195
Mailing Address - Fax:205-764-0707
Practice Address - Street 1:2109 41ST CT NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-1511
Practice Address - Country:US
Practice Address - Phone:205-535-6195
Practice Address - Fax:205-764-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access