Healthcare Provider Details

I. General information

NPI: 1598877284
Provider Name (Legal Business Name): HAZEL GREEN FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12801 HIGHWAY 231/431
HAZEL GREEN AL
35750
US

IV. Provider business mailing address

12801 HIGHWAY 231/431
HAZEL GREEN AL
35750
US

V. Phone/Fax

Practice location:
  • Phone: 256-828-6720
  • Fax: 256-828-7230
Mailing address:
  • Phone: 256-828-6720
  • Fax: 256-828-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22921
License Number StateAL

VIII. Authorized Official

Name: DR. BOBBY JAMES NEWBELL
Title or Position: CEO
Credential: M.D.
Phone: 256-828-6720