Healthcare Provider Details

I. General information

NPI: 1730149071
Provider Name (Legal Business Name): AVALON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date: 03/04/2024
Reactivation Date: 03/19/2024

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: 256-389-8904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3107
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO395
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19137
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5986
License Number StateAL

VIII. Authorized Official

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