Healthcare Provider Details

I. General information

NPI: 1023120458
Provider Name (Legal Business Name): GADSDEN HMA PHYSICIAN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BAY ST SUITE 301
GADSDEN AL
35901-5265
US

IV. Provider business mailing address

303 BAY ST SUITE 301
GADSDEN AL
35901-5265
US

V. Phone/Fax

Practice location:
  • Phone: 256-546-4793
  • Fax: 256-546-4967
Mailing address:
  • Phone: 256-546-4793
  • Fax: 256-546-4967

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: STANLEY D. MCLEMORE
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 239-598-3131