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General NPI Number Information
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NPI Number | 1346946308
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Entity Type | Organization
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Legal Business Name | ALABAMA DEVELOPMENTAL AND DIAGNOSTIC CLINIC LLC
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 105 APPLETON LN
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City | MADISON
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State | AL
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Zip | 35756-4162
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Country | US
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Telephone | 563-424-0459
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Fax |
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Provider Business Mailing Address
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Address Line | 105 APPLETON LN
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City | MADISON
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State | AL
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Zip | 35756-4162
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC A HULTQUIST
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Credential | DO
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Telephone | 563-424-0459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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