| NPI | 1699268672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE COPELAND Billing Manager/Credentialing 256-907-2493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 00013209) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AL MD13209) |
| 2083B0002X Preventive Medicine, Obesity Medicine (Licence: AL MD13209) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2018-06-13 |