Healthcare Provider Details

I. General information

NPI: 1295419901
Provider Name (Legal Business Name): LIMESTONE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15243 GREENFIELD DR STE A
ATHENS AL
35613-2899
US

IV. Provider business mailing address

15243 GREENFIELD DR STE A
ATHENS AL
35613-2899
US

V. Phone/Fax

Practice location:
  • Phone: 256-262-5700
  • Fax: 256-262-5710
Mailing address:
  • Phone: 256-262-5700
  • Fax: 256-262-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SEBRINA HOLT
Title or Position: DIRECTOR OF PHYSICIAN NETWORK
Credential:
Phone: 256-216-9648