Healthcare Provider Details

I. General information

NPI: 1629491451
Provider Name (Legal Business Name): PICKENS COUNTY PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 4TH AVE SW STE A
REFORM AL
35481-8018
US

IV. Provider business mailing address

108 4TH AVE SW STE A
REFORM AL
35481-8018
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-6251
  • Fax: 205-375-9064
Mailing address:
  • Phone: 205-375-6251
  • Fax: 205-375-9064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIA L BOOTHE
Title or Position: OWNER
Credential: MD
Phone: 205-792-6701