Healthcare Provider Details

I. General information

NPI: 1558859157
Provider Name (Legal Business Name): FLINT RIVER FAMILY MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2018
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 HIGHWAY 431 S STE 104
BROWNSBORO AL
35741-9755
US

IV. Provider business mailing address

5575 HIGHWAY 431 S STE 104
BROWNSBORO AL
35741-9755
US

V. Phone/Fax

Practice location:
  • Phone: 256-469-6487
  • Fax: 256-585-3852
Mailing address:
  • Phone: 256-469-6487
  • Fax: 256-585-3852

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: JUSTIN PRICE PRUITT
Title or Position: PRESIDENT
Credential: DO
Phone: 256-469-6487