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General NPI Number Information
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NPI Number | 1083480453
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Entity Type | Organization
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Legal Business Name | AZALEA CITY PRIMARY CARE AND WELLNESS
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 602 BEL AIR BLVD STE 14
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City | MOBILE
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State | AL
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Zip | 36606-3502
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Country | US
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Telephone | 251-372-0858
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Fax | 251-494-2034
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Provider Business Mailing Address
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Address Line | 602 BEL AIR BLVD STE 14
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City | MOBILE
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State | AL
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Zip | 36606-3502
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Country | US
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Telephone | 251-372-0858
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Fax | 844-469-0916
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TASHA LATIYA JONES
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Credential | DNP, CRNP
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Telephone | 251-422-4336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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