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General NPI Number Information
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NPI Number | 1770734543
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Entity Type | Organization
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Legal Business Name | SOUTHERN FAMILY PRACTICE,LLC
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 100 W LAKE PROFESSIONAL PARK STE 1
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City | GENEVA
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State | AL
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Zip | 36340-1200
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Country | US
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Telephone | 334-684-9400
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Fax | 334-684-6262
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Provider Business Mailing Address
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Address Line | 100 W LAKE PROFESSIONAL PARK STE 1
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City | GENEVA
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State | AL
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Zip | 36340-1200
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Country | US
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Telephone | 334-684-9400
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Fax | 334-684-6262
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. CECILIA RENEE ROBINSON
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Credential | CRNP
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Telephone | 334-684-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-074572
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License Number State |
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