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General NPI Number Information
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NPI Number | 1174281166
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Entity Type | Organization
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Legal Business Name | USA HEALTH DAPHNE FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 21950 STATE HIGHWAY 181 STE A
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City | FAIRHOPE
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State | AL
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Zip | 36532-4393
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Country | US
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Telephone | 251-621-6520
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Fax | 251-621-6521
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Provider Business Mailing Address
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Address Line | PO BOX 749429
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City | ATLANTA
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State | GA
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Zip | 30374-9429
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Country | US
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Telephone | 251-621-6520
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Fax | 251-621-6521
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Authorized Official
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Title or Position | FINANCIAL MANAGER
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Name | TISHIA JOHNSON
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Credential |
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Telephone | 251-850-5053
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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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