Healthcare Provider Details

I. General information

NPI: 1366857674
Provider Name (Legal Business Name): CHILTON URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 7TH ST S
CLANTON AL
35045-3724
US

IV. Provider business mailing address

PO BOX 130
WETUMPKA AL
36092-0003
US

V. Phone/Fax

Practice location:
  • Phone: 205-280-0620
  • Fax: 205-280-0625
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JADE LANE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 334-567-4311