Healthcare Provider Details

I. General information

NPI: 1649863630
Provider Name (Legal Business Name): PHYSICIANS CARE OF CLARKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24B CAMDEN BYP
CAMDEN AL
36726-1770
US

IV. Provider business mailing address

24B CAMDEN BYP
CAMDEN AL
36726-1770
US

V. Phone/Fax

Practice location:
  • Phone: 334-882-1919
  • Fax:
Mailing address:
  • Phone: 334-882-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FARRELL TURNER
Title or Position: CEO
Credential:
Phone: 256-201-0095