Healthcare Provider Details

I. General information

NPI: 1073791372
Provider Name (Legal Business Name): CENTRAL ALABAMA MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAY DAM RD
CLANTON AL
35045-2306
US

IV. Provider business mailing address

1010 LAY DAM ROAD
CLANTON AL
35046-1920
US

V. Phone/Fax

Practice location:
  • Phone: 205-280-4663
  • Fax: 205-280-3489
Mailing address:
  • Phone: 205-280-4663
  • Fax: 205-280-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1284-HHA
License Number StateAL

VIII. Authorized Official

Name: MR. J LEE
Title or Position: HOME HEALTH ADMINISTRATOR
Credential:
Phone: 205-280-4663