Healthcare Provider Details

I. General information

NPI: 1033451992
Provider Name (Legal Business Name): BHC-WALKER PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 HIGHWAY 78 E MEDICAL ARTS TOWER; SUITE 321
JASPER AL
35501-8907
US

IV. Provider business mailing address

3400 HIGHWAY 78 E MEDICAL ARTS TOWER; SUITE 321
JASPER AL
35501-8907
US

V. Phone/Fax

Practice location:
  • Phone: 205-715-5943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE SCOTT FENN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 205-715-5415