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General NPI Number Information
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NPI Number | 1003006289
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Entity Type | Organization
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Legal Business Name | WADDELL CENTER FAMILY MEDICINE
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 902 W WASHINGTON ST
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City | ATHENS
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State | AL
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Zip | 35611-2438
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Country | US
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Telephone | 256-216-9777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 999
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City | ATHENS
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State | AL
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Zip | 35612-0999
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Country | US
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Telephone | 256-216-9777
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE
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Name | JAMES RANDY COMER
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Credential |
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Telephone | 256-233-9172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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