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General NPI Number Information
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NPI Number | 1265705065
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Entity Type | Organization
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Legal Business Name | CLOVERDALE ROAD FAMILY MEDICAL CENTER
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 3502 CLOVERDALE RD
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City | FLORENCE
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State | AL
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Zip | 35633-1302
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Country | US
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Telephone | 256-764-1263
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Fax | 256-764-9611
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Provider Business Mailing Address
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Address Line | PO BOX 895
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City | SHEFFIELD
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State | AL
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Zip | 35660-0895
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Country | US
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Telephone | 256-764-1263
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Fax | 256-764-9611
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Authorized Official
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Title or Position | CONTROLLER
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Name | CAROLYN LEONARD
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Credential |
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Telephone | 256-386-4673
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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 | 8871
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License Number State | AL
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