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General NPI Number Information
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NPI Number | 1528544475
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Entity Type | Organization
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Legal Business Name | TUSCALOOSA PRIMARY CARE, LLC
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 100 TOWNCENTER BLVD STE 300
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City | TUSCALOOSA
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State | AL
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Zip | 35406-1835
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Country | US
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Telephone | 205-710-3838
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Fax | 205-710-3839
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Provider Business Mailing Address
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Address Line | 100 TOWNCENTER BLVD STE 300
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City | TUSCALOOSA
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State | AL
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Zip | 35406-1835
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Country | US
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Telephone | 205-710-3838
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Fax | 205-710-3839
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | JOHN DUSTIN SHEPPARD
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Credential | MD
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Telephone | 205-710-3383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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