| NPI | 1316464183 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP - FAIRHOPE |
| Entity Type | Organization |
| Authorized Contact | TODD KENNEDY President 251-633-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2017-08-23 |