Healthcare Provider Details

I. General information

NPI: 1598750762
Provider Name (Legal Business Name): PHYSICIANS CARE OF THOMASVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33621 HIGHWAY 43
THOMASVILLE AL
36784-3347
US

IV. Provider business mailing address

33621 HIGHWAY 43
THOMASVILLE AL
36784-3347
US

V. Phone/Fax

Practice location:
  • Phone: 334-636-5311
  • Fax: 334-636-2280
Mailing address:
  • Phone: 334-636-5311
  • Fax: 334-636-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HUEY RANDOLPH KIDD
Title or Position: OWNER/MANAGER
Credential: DO
Phone: 334-636-5311