Healthcare Provider Details

I. General information

NPI: 1295682615
Provider Name (Legal Business Name): DIRT ROAD ROOTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 NANCE FORD RD STE M
HARTSELLE AL
35640-7338
US

IV. Provider business mailing address

711 NANCE FORD RD SW STE M
HARTSELLE AL
35640-3767
US

V. Phone/Fax

Practice location:
  • Phone: 256-754-5021
  • Fax:
Mailing address:
  • Phone: 256-754-5021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM ROGER HENSLEY
Title or Position: PHYSICIAN
Credential:
Phone: 205-516-1321