Healthcare Provider Details

I. General information

NPI: 1407566383
Provider Name (Legal Business Name): SHOALS FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415B AVALON AVE
MUSCLE SHOALS AL
35661-3163
US

IV. Provider business mailing address

3554 WOODMONT DR
TUSCUMBIA AL
35674-5898
US

V. Phone/Fax

Practice location:
  • Phone: 256-678-8892
  • Fax: 256-383-6234
Mailing address:
  • Phone: 256-627-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY HOOD
Title or Position: CRNP
Credential:
Phone: 256-627-2852