Provider Demographics
NPI:1902940034
Name:ADVANCED UROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:ADVANCED UROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PHILIPS
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-543-1188
Mailing Address - Street 1:303 BAY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5265
Mailing Address - Country:US
Mailing Address - Phone:256-543-1188
Mailing Address - Fax:256-543-8855
Practice Address - Street 1:395 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1045
Practice Address - Country:US
Practice Address - Phone:256-927-7791
Practice Address - Fax:256-927-9156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76525Medicare UPIN