Healthcare Provider Details

I. General information

NPI: 1144301128
Provider Name (Legal Business Name): STAFF OF LIFE MED CORP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 LEIGHTON AVE
ANNISTON AL
36207-5701
US

IV. Provider business mailing address

1011 LEIGHTON AVE
ANNISTON AL
36207-5701
US

V. Phone/Fax

Practice location:
  • Phone: 256-770-7197
  • Fax: 256-405-4439
Mailing address:
  • Phone: 256-770-7197
  • Fax: 256-405-4439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number19946
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARGARET S. PORTER
Title or Position: OFF MGR
Credential:
Phone: 256-770-7197