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General NPI Number Information
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NPI Number | 1487123915
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Entity Type | Organization
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Legal Business Name | PHYSICIANS CARE OF CAMDEN LLC
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 24B CAMDEN BYP
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City | CAMDEN
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State | AL
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Zip | 36726-1770
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Country | US
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Telephone | 334-882-1919
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Fax | 334-636-1989
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Provider Business Mailing Address
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Address Line | 1145 TREVOR CIR
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City | THOMASVILLE
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State | AL
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Zip | 36784-3546
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Country | US
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Telephone | 334-534-3826
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Fax |
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Authorized Official
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Title or Position | D.O.
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Name | HUEY RANDOLPH KIDD
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Credential | D.O.
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Telephone | 334-882-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health 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 | 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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