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General NPI Number Information
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NPI Number | 1427279751
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Entity Type | Individual
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Provider Name | MARILYN G CLAUNCH RD LD
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 68 MARCO DR SE PRICEVILLE FAMILY MEDICINE SOUTHERN RURAL HEALTH CARE
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City | DECATUR
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State | AL
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Zip | 35603-0000
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Country | US
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Telephone | 256-432-2007
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Fax | 256-432-2010
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Provider Business Mailing Address
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Address Line | PO BOX 970
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-0970
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Country | US
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Telephone | 256-332-7310
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Fax | 256-331-0927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 612554
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License Number State | AL
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