Healthcare Provider Details

I. General information

NPI: 1588763312
Provider Name (Legal Business Name): COLBERT COUNTY FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 KELLER PARK BLVD
TUSCUMBIA AL
35674-1416
US

IV. Provider business mailing address

130 KELLER PARK BLVD
TUSCUMBIA AL
35674-1416
US

V. Phone/Fax

Practice location:
  • Phone: 256-381-0085
  • Fax: 256-381-0907
Mailing address:
  • Phone: 256-381-0085
  • Fax: 256-381-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9181811
License Number StateAL

VIII. Authorized Official

Name: DR. FLORA KAYFAN
Title or Position: OWNER
Credential: M.D.
Phone: 256-381-0085