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General NPI Number Information
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NPI Number | 1083758338
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Entity Type | Organization
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Legal Business Name | DR RITKY C DY MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 1221 7TH ST S
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City | CLANTON
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State | AL
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Zip | 35045-3723
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Country | US
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Telephone | 205-280-6789
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Fax | 205-280-1350
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Provider Business Mailing Address
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Address Line | PO BOX 109
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City | CLANTON
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State | AL
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Zip | 35046-0109
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Country | US
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Telephone | 205-280-6789
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Fax | 205-280-1350
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Authorized Official
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Title or Position | OWNER
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Name | DR. RITKY C DY
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Credential | M.D.
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Telephone | 205-280-6789
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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 | 18537
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License Number State | AL
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