Healthcare Provider Details

I. General information

NPI: 1407931462
Provider Name (Legal Business Name): ATC MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 TANNER WILLIAMS RD
MOBILE AL
36608-8322
US

IV. Provider business mailing address

900 DOWNTOWNER BLVD APT 143
MOBILE AL
36609-9405
US

V. Phone/Fax

Practice location:
  • Phone: 251-441-6560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number StateAL

VIII. Authorized Official

Name: JUSTIN CRAIG PEASE
Title or Position: HS3
Credential:
Phone: 251-441-6560