Healthcare Provider Details

I. General information

NPI: 1831764984
Provider Name (Legal Business Name): CAHABA CONCIERGE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8011 LIBERTY PKWY STE 101
VESTAVIA AL
35242-7670
US

IV. Provider business mailing address

8011 LIBERTY PKWY STE 101
VESTAVIA AL
35242-7670
US

V. Phone/Fax

Practice location:
  • Phone: 205-255-4024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: DR. KATHERINE ALFORD MOORE
Title or Position: PHYSICIAN OWNER
Credential:
Phone: 205-968-5988