| Southern Grace Medical Care, Llc | |
|
500 Governors Dr Sw Huntsville AL 35801-5126 | |
| (256) 797-4118 | |
| Not Available |
| Full Name | Southern Grace Medical Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 500 Governors Dr Sw, Huntsville, Alabama |
| Authorized Official Name and Position | Jimmy Gregory Winn (FAMILY NURSE PRACTITIONER / OWNER) |
| Authorized Official Contact | 2567974118 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Grace Medical Care, Llc 1606 Moontown Rd Brownsboro AL 35741-9493 Ph: (256) 776-3850 | Southern Grace Medical Care, Llc 500 Governors Dr Sw Huntsville AL 35801-5126 Ph: (256) 797-4118 |
| NPI Number | 1649890211 |
|---|---|
| Provider Enumeration Date | 04/23/2020 |
| Last Update Date | 04/23/2020 |
| Medicare PECOS PAC ID | 4082031497 |
|---|---|
| Medicare Enrollment ID | O20200831003141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649890211 | NPI | - | NPPES |
| 23529 | Other | AL | ALABAMA BOARD OF MEDICAL EXAMINERS |
| 8499 | Other | AL | ALABAMA BOARD OF NURSING, RX NUMBER |
| 1-159682 | Other | AL | ALABAMA BOARD OF NURSING, RN LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Perry L Swann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871589481 PECOS PAC ID: 5890960249 Enrollment ID: I20111213000559 |
| Provider Name | Jimmy Gregory Winn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124648258 PECOS PAC ID: 5991122301 Enrollment ID: I20200831003300 |
| Provider Name | Davonia Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508483454 PECOS PAC ID: 0648647164 Enrollment ID: I20221111001873 |
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