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General NPI Number Information
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NPI Number | 1457843708
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Entity Type | Organization
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Legal Business Name | JMAC MED LLC
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Dates
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Enumeration Date | 06/02/2018
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Last Update Date | 06/02/2018
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Provider Practice Location Address
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Address Line | 4951 WILSON DAM RD
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City | TUSCUMBIA
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State | AL
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Zip | 35674-9141
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Country | US
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Telephone | 256-856-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 4951 WILSON DAM RD
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City | TUSCUMBIA
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State | AL
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Zip | 35674-9141
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Country | US
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Telephone | 256-856-2424
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. JEREMY PAUL TAYLOR
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Credential |
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Telephone | 256-856-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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