Healthcare Provider Details

I. General information

NPI: 1659139772
Provider Name (Legal Business Name): AVALON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 AVALON AVE
MUSCLE SHOALS AL
35661-3283
US

IV. Provider business mailing address

PO BOX 2550
MUSCLE SHOALS AL
35662-2550
US

V. Phone/Fax

Practice location:
  • Phone: 256-386-0808
  • Fax: 256-389-8904
Mailing address:
  • Phone: 256-386-0808
  • Fax: 256-381-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LOREN E MCCOY
Title or Position: PRESIDENT
Credential: MD
Phone: 256-386-0808