Healthcare Provider Details

I. General information

NPI: 1174675144
Provider Name (Legal Business Name): PICKENS COUNTY FAMILY PRACTICE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27340 HWY 86
GORDO AL
35466-7340
US

IV. Provider business mailing address

27340 HIGHWAY 86
GORDO AL
35466
US

V. Phone/Fax

Practice location:
  • Phone: 205-364-7135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8876
License Number StateAL

VIII. Authorized Official

Name: DR. JOHN BRANDON
Title or Position: PRESIDENT
Credential:
Phone: 205-364-7135