MEDICARE: MMC, M.D., LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1316559917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MMC, M.D., LLC

Provider Business Mailing Address
First Line	:	3509 WATERMELON RD
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-5174
Country	:	US
Telephone Number	:	205-366-0221
Fax Number	:	205-366-0342

Provider Business Practice Location Address
First Line	:	3509 WATERMELON RD
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-5174
Country	:	US
Telephone Number	:	205-366-0221
Fax Number	:	205-366-0342

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MICHELLE HAWTHORNE
Credential	:	MS
Telephone Number	:	205-997-2417

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	02/09/2026

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