Healthcare Provider Details

I. General information

NPI: 1518301837
Provider Name (Legal Business Name): FALKVILLE MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 E PIKE RD
FALKVILLE AL
35622-5109
US

IV. Provider business mailing address

434 E PIKE RD
FALKVILLE AL
35622-5109
US

V. Phone/Fax

Practice location:
  • Phone: 256-784-2200
  • Fax: 256-784-2203
Mailing address:
  • Phone: 256-784-2200
  • Fax: 256-784-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SLOAN GRAHAM
Title or Position: VP OF OPERATIONS
Credential: FNP-C
Phone: 256-432-2822