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General NPI Number Information
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NPI Number | 1427566181
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Entity Type | Organization
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Legal Business Name | CLINIC OF GADSDEN, PC
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 1401 RAINBOW DR STE B
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City | GADSDEN
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State | AL
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Zip | 35901-5319
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Country | US
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Telephone | 256-646-6358
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860
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City | GADSDEN
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State | AL
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Zip | 35902-0860
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Country | US
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Telephone | 256-646-6358
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN HUBBARD FULLER
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Credential | DO
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Telephone | 256-646-6358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO.1762
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License Number State | AL
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