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General NPI Number Information
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NPI Number | 1437275112
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Entity Type | Organization
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Legal Business Name | DIABETIC CARE CLINIC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 1530 US HIGHWAY 43
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City | WINFIELD
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State | AL
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Zip | 35594-5056
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Country | US
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Telephone | 205-487-7730
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Fax |
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Provider Business Mailing Address
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Address Line | 1530 US HIGHWAY 43
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City | WINFIELD
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State | AL
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Zip | 35594-5056
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Country | US
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Telephone | 205-487-7730
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. BONNIE EMERSON
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Credential |
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Telephone | 205-468-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1048518
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License Number State | AL
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