Healthcare Provider Details

I. General information

NPI: 1205340460
Provider Name (Legal Business Name): MEDICAL CARE ASSOCIATES PRATTVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 MCQUEEN SMITH RD N STE 302B
PRATTVILLE AL
36066-7269
US

IV. Provider business mailing address

2641 OAKLEAF CIR
HELENA AL
35022-7230
US

V. Phone/Fax

Practice location:
  • Phone: 334-361-7404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DERRICK BROWN
Title or Position: MEMBER
Credential:
Phone: 205-253-2205