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General NPI Number Information
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NPI Number | 1831353846
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Entity Type | Organization
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Legal Business Name | JASPER DOCTORS CLINIC AND URGENT CARE INC.
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 4330 HIGHWAY 78 E STE 115 MEDICAL PLAZA EAST 114-115
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City | JASPER
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State | AL
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Zip | 35501-8955
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Country | US
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Telephone | 205-295-0002
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Fax | 205-295-0991
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Provider Business Mailing Address
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Address Line | 4330 HIGHWAY 78 E STE 115 MEDICAL PLAZA EAST 114-115
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City | JASPER
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State | AL
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Zip | 35501-8955
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Country | US
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Telephone | 205-295-0002
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Fax | 205-295-0991
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Authorized Official
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Title or Position | OWNER
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Name | BOLANLE O. GBADEBO
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Credential | M.D
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Telephone | 205-295-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MEDICAID 102173
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License Number State | AL
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