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General NPI Number Information
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NPI Number | 1104629740
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Entity Type | Organization
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Legal Business Name | FLORALA MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 03/29/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 24245 5TH AVE
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City | FLORALA
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State | AL
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Zip | 36442-3523
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Country | US
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Telephone | 334-858-1171
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Fax | 334-858-1184
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Provider Business Mailing Address
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Address Line | PO BOX 342
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City | FLORALA
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State | AL
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Zip | 36442-0342
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Country | US
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Telephone | 334-858-1171
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Fax | 334-858-1184
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MS. TRACY ODOM
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Credential | CRNP
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Telephone | 334-858-1171
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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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