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218 Main Street Fulton AL 36446-2000 | |
(334) 636-4823 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 218 Main Street, Fulton, Alabama |
Authorized Official Name and Position | H Douglas Sewell (CEO) |
Authorized Official Contact | 2512753191 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 935 Grove Hill AL 36451-0935 Ph: (251) 275-3191 | 218 Main Street Fulton AL 36446-2000 Ph: (334) 636-4823 |
NPI Number | 1144270257 |
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Provider Enumeration Date | 05/11/2006 |
Last Update Date | 08/06/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144270257 | NPI | - | NPPES |
540003922 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |