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General NPI Number Information
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NPI Number | 1174719736
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Entity Type | Organization
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Legal Business Name | WELLSPOT MEDICAL CLINICS
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 2125 DATA OFFICE DR SUITE 102
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City | BIRMINGHAM
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State | AL
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Zip | 35244-2529
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Country | US
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Telephone | 205-988-9577
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Fax | 205-985-8891
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Provider Business Mailing Address
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Address Line | 2125 DATA OFFICE DR SUITE 102
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City | BIRMINGHAM
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State | AL
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Zip | 35244-2529
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Country | US
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Telephone | 205-988-9577
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Fax |
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Authorized Official
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Title or Position | AREA BRANCH MANAGER
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Name | MR. TIMOTHY FLEMING
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Credential | NP
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Telephone | 205-988-9577
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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 | 1077717
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License Number State | AL
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