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General NPI Number Information
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NPI Number | 1619559812
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Entity Type | Organization
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Legal Business Name | EVERGREEN MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 225 PATTERSON AVE # A
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City | GEORGIANA
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State | AL
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Zip | 36033-6628
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Country | US
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Telephone | 251-578-2480
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 706
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City | EVERGREEN
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State | AL
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Zip | 36401-0706
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Country | US
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Telephone | 251-578-2480
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MELISSA DIANE DUNN
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Credential |
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Telephone | 251-578-2480
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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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