Healthcare Provider Details

I. General information

NPI: 1518108646
Provider Name (Legal Business Name): MMG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 COMMERCE CIR SW STE A
DECATUR AL
35601-6839
US

IV. Provider business mailing address

PO BOX 622
DECATUR AL
35602-0622
US

V. Phone/Fax

Practice location:
  • Phone: 866-374-4377
  • Fax: 877-359-9789
Mailing address:
  • Phone: 866-374-4377
  • Fax: 877-359-9789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELODY GILL
Title or Position: PRESIDENT
Credential:
Phone: 866-374-4377