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General NPI Number Information
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NPI Number | 1245827203
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Entity Type | Organization
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Legal Business Name | BOAZ AND ALBERTVILLE FAMILY CARE, LLC
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Dates
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Enumeration Date | 12/24/2020
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 214 S MCCLESKEY ST STE 863
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City | BOAZ
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State | AL
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Zip | 35957-2187
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Country | US
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Telephone | 256-849-0500
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Fax | 339-770-7908
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Provider Business Mailing Address
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Address Line | PO BOX 22
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City | BOAZ
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State | AL
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Zip | 35957-0022
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Country | US
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Telephone | 256-849-0500
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Fax | 256-573-1021
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Authorized Official
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Title or Position | OWNER
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Name | MESSALINA JORDAN
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Credential | DO
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Telephone | 205-451-6711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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