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201 Henry Rd Sw Jacksonville AL 36265-3324 | |
| (256) 435-1871 | |
| (256) 435-5703 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 201 Henry Rd Sw, Jacksonville, Alabama |
| Authorized Official Name and Position | Lawrence Stanley Rosen (DIRECTOR) |
| Authorized Official Contact | 2564351871 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 339 Jacksonville AL 36265-0339 Ph: (256) 435-1871 | 201 Henry Rd Sw Jacksonville AL 36265-3324 Ph: (256) 435-1871 |
| NPI Number | 1841420049 |
|---|---|
| Provider Enumeration Date | 07/22/2009 |
| Last Update Date | 10/29/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841420049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 12000 (Alabama) | Primary |
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