Healthcare Provider Details

I. General information

NPI: 1750997706
Provider Name (Legal Business Name): COMPREHENSIVE PRIMARY & URGENT CARE OF ALABAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W MARKET ST
ATHENS AL
35611-2463
US

IV. Provider business mailing address

707 W MARKET ST STE C
ATHENS AL
35611-2463
US

V. Phone/Fax

Practice location:
  • Phone: 256-444-1815
  • Fax:
Mailing address:
  • Phone: 256-444-1815
  • Fax: 256-444-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AUDRA E MOORE
Title or Position: MEMBER
Credential: NP
Phone: 256-777-0000