Healthcare Provider Details

I. General information

NPI: 1134473952
Provider Name (Legal Business Name): PICKENS COUNTY HEALTH CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27340 HIGHWAY 86
GORDO AL
35466-3578
US

IV. Provider business mailing address

PO BOX 360
CARROLLTON AL
35447-0360
US

V. Phone/Fax

Practice location:
  • Phone: 205-364-7135
  • Fax: 205-364-8244
Mailing address:
  • Phone: 205-364-7135
  • Fax: 205-364-8244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. REGINA A BEAMS
Title or Position: UNIT LEADER PHYSICIAN SEVICES
Credential:
Phone: 205-367-8111