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General NPI Number Information
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NPI Number | 1144301128
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Entity Type | Organization
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Legal Business Name | STAFF OF LIFE MED CORP PC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 1011 LEIGHTON AVE
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City | ANNISTON
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State | AL
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Zip | 36207-5701
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Country | US
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Telephone | 256-770-7197
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Fax | 256-405-4439
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Provider Business Mailing Address
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Address Line | 1011 LEIGHTON AVE
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City | ANNISTON
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State | AL
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Zip | 36207-5701
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Country | US
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Telephone | 256-770-7197
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Fax | 256-405-4439
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Authorized Official
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Title or Position | OFF MGR
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Name | MRS. MARGARET S. PORTER
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Credential |
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Telephone | 256-770-7197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 19946
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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