Healthcare Provider Details

I. General information

NPI: 1295699635
Provider Name (Legal Business Name): SUPER KIDS URGENT CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 SUTTON RD SE STE A
OWENS CROSS ROADS AL
35763-9422
US

IV. Provider business mailing address

322 SUTTON RD SE STE A
OWENS CROSS ROADS AL
35763-9422
US

V. Phone/Fax

Practice location:
  • Phone: 601-540-8782
  • Fax:
Mailing address:
  • Phone: 601-540-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MACON C. OVERTON III
Title or Position: OWNER, NURSE PRACTITIONER
Credential: PNP-AC/PC
Phone: 601-540-8782