Healthcare Provider Details

I. General information

NPI: 1063804052
Provider Name (Legal Business Name): FULTONDALE URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 WALKER CHAPEL PLZ SUITE 115
FULTONDALE AL
35068-3401
US

IV. Provider business mailing address

339 WALKER CHAPEL PLZ SUITE 115
FULTONDALE AL
35068-3401
US

V. Phone/Fax

Practice location:
  • Phone: 205-841-2844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOUG RANDALL
Title or Position: COO
Credential:
Phone: 205-841-2844