MEDICARE: DOCTORS MAKING HOME VISITS 1ST INC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1750906921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS MAKING HOME VISITS 1ST INC

Provider Business Mailing Address
First Line	:	922 S PERRY ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-5022
Country	:	US
Telephone Number	:	334-303-0657
Fax Number	:

Provider Business Practice Location Address
First Line	:	922 S PERRY ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-5022
Country	:	US
Telephone Number	:	334-303-0657
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TISHA DENISE DICKSON-NICKSON
Credential	:
Telephone Number	:	334-303-0657

Provider Enumeration Date	:	06/12/2020
Last Update Date	:	06/12/2020

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