Healthcare Provider Details

I. General information

NPI: 1477664779
Provider Name (Legal Business Name): SARALAND FAMILY PRACT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 ENNIS ST
SARALAND AL
36571-2706
US

IV. Provider business mailing address

119 ENNIS ST
SARALAND AL
36571-2706
US

V. Phone/Fax

Practice location:
  • Phone: 251-544-2000
  • Fax: 251-544-2004
Mailing address:
  • Phone: 251-544-2000
  • Fax: 251-544-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00012136
License Number StateAL

VIII. Authorized Official

Name: DR. MARK A MCDANIEL
Title or Position: MD/OWNER
Credential: M.D.
Phone: 251-544-2000