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General NPI Number Information
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NPI Number | 1295699635
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Entity Type | Organization
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Legal Business Name | SUPER KIDS URGENT CARE, PLLC
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 322 SUTTON RD SE STE A
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-9422
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Country | US
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Telephone | 601-540-8782
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Fax |
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Provider Business Mailing Address
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Address Line | 322 SUTTON RD SE STE A
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-9422
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Country | US
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Telephone | 601-540-8782
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Fax |
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Authorized Official
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Title or Position | OWNER, NURSE PRACTITIONER
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Name | MR. MACON C. OVERTON III
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Credential | PNP-AC/PC
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Telephone | 601-540-8782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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