Healthcare Provider Details

I. General information

NPI: 1629121553
Provider Name (Legal Business Name): CHILTON MEDICAL GROUP P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MEDICAL CENTER DR
CLANTON AL
35045-2332
US

IV. Provider business mailing address

108 MEDICAL CENTER DR
CLANTON AL
35045-2332
US

V. Phone/Fax

Practice location:
  • Phone: 205-755-5700
  • Fax: 888-418-7660
Mailing address:
  • Phone: 205-755-5700
  • Fax: 205-755-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: HEATHER RENEE GANN
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-755-5700