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General NPI Number Information
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NPI Number | 1700943602
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Entity Type | Organization
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Legal Business Name | PIEDMONT FAMILY PRACTICE CENTER PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 25 ROUNDTREE DR
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City | PIEDMONT
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State | AL
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Zip | 36272-5893
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Country | US
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Telephone | 256-447-9045
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Fax | 256-447-9040
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Provider Business Mailing Address
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Address Line | PO BOX 450
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City | PIEDMONT
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State | AL
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Zip | 36272-0450
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Country | US
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Telephone | 256-447-9045
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUSSELL DEAN ULRICH
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Credential | D.O.
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Telephone | 256-447-9045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | DO-47
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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