Healthcare Provider Details

I. General information

NPI: 1023314937
Provider Name (Legal Business Name): ALABAMA FAMILY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5553 HIGHWAY 90
PACE FL
32571-1540
US

IV. Provider business mailing address

4701 AIRPORT BLVD SUITE 200
MOBILE AL
36608-3187
US

V. Phone/Fax

Practice location:
  • Phone: 850-995-8811
  • Fax: 850-995-8810
Mailing address:
  • Phone: 850-995-8811
  • Fax: 850-995-8810

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: PURUSHOTTAM GARG
Title or Position: PHYSICIAN
Credential:
Phone: 850-995-8811