Healthcare Provider Details

I. General information

NPI: 1780039297
Provider Name (Legal Business Name): MERCY FAMILY HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MITYLENE PARK DR.
MONTGOMERY AL
36117-3548
US

IV. Provider business mailing address

128 MITYLENE PARK DR.
MONTGOMERY AL
36117-3548
US

V. Phone/Fax

Practice location:
  • Phone: 334-239-7020
  • Fax: 334-239-7034
Mailing address:
  • Phone: 334-239-7020
  • Fax: 334-239-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-103472
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-103472
License Number StateAL

VIII. Authorized Official

Name: DR. LILIAN IFEOMA AKWUBA
Title or Position: PRESIDENT
Credential: DNP-CRNP
Phone: 334-239-7020