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General NPI Number Information
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NPI Number | 1760204820
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Entity Type | Organization
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Legal Business Name | SHERROD FAMILY MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 907A 31ST ST E
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City | TUSCALOOSA
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State | AL
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Zip | 35405-2507
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Country | US
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Telephone | 662-352-3817
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Fax |
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Provider Business Mailing Address
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Address Line | 4699 COUNTY ROAD 75
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City | ETHELSVILLE
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State | AL
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Zip | 35461-3221
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Country | US
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Telephone | 662-352-3817
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | PRELINCA SHERROD
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Credential | FNP
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Telephone | 662-352-3817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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