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General NPI Number Information
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NPI Number | 1467909978
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Entity Type | Organization
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Legal Business Name | SOUTHERN IMMEDIATE CARE, LLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 4100 MCCLELLAN BLVD
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City | ANNISTON
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State | AL
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Zip | 36201-2132
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Country | US
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Telephone | 256-235-2273
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Fax | 256-235-2277
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Provider Business Mailing Address
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Address Line | PO BOX 8164
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City | GADSDEN
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State | AL
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Zip | 35902-8164
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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 | JASON JUNKINS
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Credential | MD
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Telephone | 256-848-0481
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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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