Provider Demographics
NPI:1447868757
Name:ADVENT HEALTH LLC
Entity type:Organization
Organization Name:ADVENT HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-325-0955
Mailing Address - Street 1:1230 SLAUGHTER RD STE C
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-5901
Mailing Address - Country:US
Mailing Address - Phone:256-325-0955
Mailing Address - Fax:
Practice Address - Street 1:1230 SLAUGHTER RD STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-5901
Practice Address - Country:US
Practice Address - Phone:256-325-0955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty