Provider Demographics
NPI:1043304835
Name:FORMWALT AND WILLIAMS INC
Entity type:Organization
Organization Name:FORMWALT AND WILLIAMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOYELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-776-1217
Mailing Address - Street 1:POST OFFICE BOX 850818
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0818
Mailing Address - Country:US
Mailing Address - Phone:251-776-1217
Mailing Address - Fax:251-776-1219
Practice Address - Street 1:7305 COTTAGE HILL ROAD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695
Practice Address - Country:US
Practice Address - Phone:251-776-1217
Practice Address - Fax:251-776-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL504103TC0700X
AL593103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R38382OtherBC & BS DR ANNIE FORMWALT
R82618OtherBCBS DR LUCILE T WILLIAMS
R82618OtherBCBS DR LUCILE T WILLIAMS
R38382OtherBC & BS DR ANNIE FORMWALT