Healthcare Provider Details

I. General information

NPI: 1891165437
Provider Name (Legal Business Name): CAHABA MEDICAL CARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 9TH AVE SW STE 210
BESSEMER AL
35022-7839
US

IV. Provider business mailing address

405 BELCHER ST
CENTREVILLE AL
35042-2946
US

V. Phone/Fax

Practice location:
  • Phone: 205-926-2992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberPA. 1067
License Number StateAL

VIII. Authorized Official

Name: JOHN WAITS
Title or Position: CEO
Credential: M.D.
Phone: 205-926-2992