Healthcare Provider Details

I. General information

NPI: 1033155791
Provider Name (Legal Business Name): ATTENTUS MOULTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TENNESSEE STREET
COURTLAND AL
35618
US

IV. Provider business mailing address

350 TENNESSEE STREET
COURTLAND AL
35618
US

V. Phone/Fax

Practice location:
  • Phone: 256-637-8033
  • Fax: 256-637-9424
Mailing address:
  • Phone: 256-637-8033
  • Fax: 256-637-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEAN GRIFFIN
Title or Position: CEO
Credential:
Phone: 256-974-2286