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General NPI Number Information
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NPI Number | 1740477389
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Entity Type | Organization
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Legal Business Name | TRUSSVILLE FAMILY HEALTHCARE PC
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 159 MAIN ST
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City | TRUSSVILLE
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State | AL
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Zip | 35173-1435
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Country | US
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Telephone | 205-655-2110
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Fax | 205-655-7020
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Provider Business Mailing Address
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Address Line | 159 MAIN ST
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City | TRUSSVILLE
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State | AL
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Zip | 35173-1435
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Country | US
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Telephone | 205-655-2110
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Fax | 205-655-7020
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Authorized Official
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Title or Position | CEO
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Name | DR. RANDOLPH LEE LAMBERSON
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Credential | MD
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Telephone | 205-655-2110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 15951
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License Number State | AL
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