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700 Pelham Rd N Jacksonville AL 36265-1602 | |
| (256) 782-5369 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine - Sports Medicine |
| Location | 700 Pelham Rd N, Jacksonville, Alabama |
| Authorized Official Name and Position | Mouzon Bass (AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5050 Spring Valley Rd. Dallas TX 75244-3909 Ph: () - | 700 Pelham Rd N Jacksonville AL 36265-1602 Ph: (256) 782-5369 |
| NPI Number | 1548717119 |
|---|---|
| Provider Enumeration Date | 09/01/2016 |
| Last Update Date | 09/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548717119 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 10954 (Alabama) | Primary |
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