Healthcare Provider Details

I. General information

NPI: 1407051063
Provider Name (Legal Business Name): DALE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 HOSPITAL AVE
OZARK AL
36360-2018
US

IV. Provider business mailing address

PO BOX 863
OZARK AL
36361-0863
US

V. Phone/Fax

Practice location:
  • Phone: 334-774-2601
  • Fax: 334-443-0131
Mailing address:
  • Phone: 334-443-1211
  • Fax: 334-443-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. VERNON L. JOHNSON
Title or Position: CEO
Credential:
Phone: 334-774-2601