Healthcare Provider Details

I. General information

NPI: 1669098943
Provider Name (Legal Business Name): THOMASVILLE REGIONAL MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MED PARK DR
THOMASVILLE AL
36784-5760
US

IV. Provider business mailing address

300 MED PARK DR
THOMASVILLE AL
36784-5760
US

V. Phone/Fax

Practice location:
  • Phone: 334-636-2525
  • Fax: 334-621-7111
Mailing address:
  • Phone: 334-636-2525
  • Fax: 334-621-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BREANNA BRICKNER
Title or Position: CONTROLLER
Credential:
Phone: 205-903-2392