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General NPI Number Information
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NPI Number | 1679913784
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Entity Type | Organization
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Legal Business Name | LAKELAND PHYSICIAN PRACTICES LLC
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Dates
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Enumeration Date | 07/03/2013
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 42030 HIGHWAY 195 SUITE D
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City | HALEYVILLE
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State | AL
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Zip | 35565-7054
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Country | US
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Telephone | 205-485-7243
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1085
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City | HALEYVILLE
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State | AL
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Zip | 35565-1085
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Country | US
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Telephone | 205-485-7243
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Fax | 205-485-7244
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Authorized Official
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Title or Position | SENIOR DIRECTOR
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Name | ANGIE MANGUM
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Credential |
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Telephone | 615-565-1898
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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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