Healthcare Provider Details

I. General information

NPI: 1851780951
Provider Name (Legal Business Name): LAKELAND PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42030 HIGHWAY 195 STE A
HALEYVILLE AL
35565-7054
US

IV. Provider business mailing address

42030 HIGHWAY 195 STE A
HALEYVILLE AL
35565-7054
US

V. Phone/Fax

Practice location:
  • Phone: 205-485-7243
  • Fax: 205-485-7244
Mailing address:
  • Phone: 205-485-7243
  • Fax: 205-485-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE CLAPP
Title or Position: PRESIDENT
Credential:
Phone: 205-485-7243