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General NPI Number Information
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NPI Number | 1518219716
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Entity Type | Organization
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Legal Business Name | PEPPERELL PRIMARY CARE, PC
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 1245 E SOUTH BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36116-2315
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Country | US
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Telephone | 334-281-3030
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Fax | 334-281-4566
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Provider Business Mailing Address
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Address Line | 1245 E SOUTH BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36116-2315
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Country | US
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Telephone | 334-281-3030
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Fax | 334-281-4566
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID J KNAPP
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Credential | M.D.
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Telephone | 334-233-2417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD.12134
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License Number State | AL
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