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General NPI Number Information
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NPI Number | 1811288038
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Entity Type | Organization
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Legal Business Name | SOUTH ALABAMA MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 10075 GRAND BAY WILMER RD S
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City | GRAND BAY
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State | AL
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Zip | 36541-5003
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Country | US
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Telephone | 251-865-1852
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Fax | 251-865-1854
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Provider Business Mailing Address
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Address Line | 10075 GRAND BAY WILMER RD S
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City | GRAND BAY
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State | AL
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Zip | 36541-5003
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Country | US
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Telephone | 251-865-1852
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Fax | 251-865-1854
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRIDGOT PETERS
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Credential |
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Telephone | 251-445-7618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 1-072232
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License Number State | AL
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | AL
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