Healthcare Provider Details

I. General information

NPI: 1326077108
Provider Name (Legal Business Name): SOUTHERN FAMILY PRACTICE AND OCCUPATIONAL MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 QUINTARD AVE
ANNISTON AL
36201-5758
US

IV. Provider business mailing address

PO BOX 457
ANNISTON AL
36202-0457
US

V. Phone/Fax

Practice location:
  • Phone: 256-236-9400
  • Fax: 256-238-1498
Mailing address:
  • Phone: 256-236-9400
  • Fax: 256-238-1498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberDO-113
License Number StateAL

VIII. Authorized Official

Name: DONALD WAYNE CASEY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 256-236-9400