Healthcare Provider Details

I. General information

NPI: 1114118064
Provider Name (Legal Business Name): COMMUNITY MEDICAL ARTS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 FRIENDSHIP RD
TALLASSEE AL
36078-1234
US

IV. Provider business mailing address

875 FRIENDSHIP RD
TALLASSEE AL
36078-1234
US

V. Phone/Fax

Practice location:
  • Phone: 334-283-3111
  • Fax: 334-283-3156
Mailing address:
  • Phone: 334-283-3111
  • Fax: 334-283-3156

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: MELVIN D. RUSSELL
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 334-283-3111