Healthcare Provider Details

I. General information

NPI: 1225507692
Provider Name (Legal Business Name): PATRIOT HEALTHCARE OF ALABAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE WEST LAKESHORE DRIVE SUITE 250
BIRMINGHAM AL
35209
US

IV. Provider business mailing address

100 ARRICOLA AVENUE
ST. AUGUSTINE FL
32080
US

V. Phone/Fax

Practice location:
  • Phone: 205-420-8629
  • Fax:
Mailing address:
  • Phone: 904-825-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID A. CULVER
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-825-4368