Healthcare Provider Details

I. General information

NPI: 1659697696
Provider Name (Legal Business Name): FULTONDALE URGENT CARE CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 WALKER CHAPEL PLAZA SUITE 115
FULTONDALE AL
35068
US

IV. Provider business mailing address

339 WALKER CHAPEL PLAZA SUITE 115
FULTONDALE AL
35068
US

V. Phone/Fax

Practice location:
  • Phone: 205-841-2844
  • Fax: 205-380-7579
Mailing address:
  • Phone: 205-841-2844
  • Fax: 205-380-7579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH C. RANDALL
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 205-310-3902