| NPI | 1649569963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT ALAN TIDWELL Pres 205-343-7743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 27746) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-079816) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2011-04-11 |