Healthcare Provider Details

I. General information

NPI: 1376870741
Provider Name (Legal Business Name): GORMAN'S MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 03/14/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 GRAND AVENUE SW
FORT PAYNE AL
35967
US

IV. Provider business mailing address

907 GRAND AVENUE SW
FORT PAYNE AL
35967
US

V. Phone/Fax

Practice location:
  • Phone: 256-845-0428
  • Fax: 256-845-0428
Mailing address:
  • Phone: 256-845-0428
  • Fax: 256-845-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14962
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOLEEN J GORMAN
Title or Position: MEMBER
Credential: M.D.
Phone: 256-845-0428