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General NPI Number Information
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NPI Number | 1053189662
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Entity Type | Organization
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Legal Business Name | COASTAL RIVER WELLNESS OF ALABAMA
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 620 HIGHWAY 43 S STE F
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City | SARALAND
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State | AL
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Zip | 36571-3603
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Country | US
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Telephone | 251-510-8134
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Fax |
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Provider Business Mailing Address
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Address Line | 9560 GALLOPS CREEK DR
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City | WILMER
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State | AL
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Zip | 36587-9300
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Country | US
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Telephone | 251-510-8134
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH ELISABETH SHEPPARD
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Credential |
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Telephone | 251-510-8134
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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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