Provider Demographics
NPI:1528107000
Name:AZALEA CITY PHYSICIANS FOR WOMEN,PC
Entity type:Organization
Organization Name:AZALEA CITY PHYSICIANS FOR WOMEN,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:GALLASPY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:251-344-5265
Mailing Address - Street 1:3715 DAUPHIN ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1771
Mailing Address - Country:US
Mailing Address - Phone:251-344-5265
Mailing Address - Fax:251-344-5321
Practice Address - Street 1:3715 DAUPHIN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1771
Practice Address - Country:US
Practice Address - Phone:251-344-5265
Practice Address - Fax:251-344-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.5725207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty