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General NPI Number Information
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NPI Number | 1518108646
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Entity Type | Organization
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Legal Business Name | MMG, LLC
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 207 COMMERCE CIR SW STE A
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City | DECATUR
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State | AL
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Zip | 35601-6839
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Country | US
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Telephone | 866-374-4377
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Fax | 877-359-9789
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Provider Business Mailing Address
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Address Line | PO BOX 622
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City | DECATUR
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State | AL
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Zip | 35602-0622
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Country | US
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Telephone | 866-374-4377
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Fax | 877-359-9789
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MELODY GILL
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Credential |
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Telephone | 866-374-4377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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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 |
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License Number State |
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