Healthcare Provider Details

I. General information

NPI: 1003060328
Provider Name (Legal Business Name): FAMILY PRACTICE CLINIC P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 MIDLAND ST
ASHFORD AL
36312
US

IV. Provider business mailing address

1245 WESTGATE PKWY
DOTHAN AL
36303
US

V. Phone/Fax

Practice location:
  • Phone: 334-899-3363
  • Fax:
Mailing address:
  • Phone: 334-793-9595
  • Fax: 334-793-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOYCE HUFFAKER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 334-793-9595