Healthcare Provider Details

I. General information

NPI: 1225308893
Provider Name (Legal Business Name): TBF&C INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 N WILSON ST POB 358
GENEVA AL
36340-1611
US

IV. Provider business mailing address

803 N WILSON ST POB 358
GENEVA AL
36340-1611
US

V. Phone/Fax

Practice location:
  • Phone: 334-684-3218
  • Fax:
Mailing address:
  • Phone: 334-684-3218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1108
License Number StateAL

VIII. Authorized Official

Name: DR. DWIGHT LAMAR CREWS II
Title or Position: OWNER
Credential: D.C.
Phone: 334-684-3218