=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548359466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF CLAYTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 08/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 S MIDWAY ST
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-775-3365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 601
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36016-0601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-775-3356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | KERRY P GULLEDGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-775-3365
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 178
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------