Healthcare Provider Details

I. General information

NPI: 1457843708
Provider Name (Legal Business Name): JMAC MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2018
Last Update Date: 06/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 WILSON DAM RD
TUSCUMBIA AL
35674-9141
US

IV. Provider business mailing address

4951 WILSON DAM RD
TUSCUMBIA AL
35674-9141
US

V. Phone/Fax

Practice location:
  • Phone: 256-856-2424
  • Fax:
Mailing address:
  • Phone: 256-856-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEREMY PAUL TAYLOR
Title or Position: CO-OWNER
Credential:
Phone: 256-856-2424