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General NPI Number Information
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NPI Number | 1336474964
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Entity Type | Organization
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Legal Business Name | SLCM LLC
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 4310 WATERMELON RD
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City | NORTHPORT
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State | AL
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Zip | 35473-5166
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Country | US
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Telephone | 205-330-5266
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Fax | 205-330-9915
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Provider Business Mailing Address
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Address Line | 4310 WATERMELON RD
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City | NORTHPORT
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State | AL
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Zip | 35473-5166
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Country | US
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Telephone | 205-330-5266
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Fax | 205-330-9915
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | NICOLE JONES
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Credential |
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Telephone | 205-710-6129
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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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