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General NPI Number Information
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NPI Number | 1891316758
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Entity Type | Organization
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Legal Business Name | MODERN HEALTH FAMILY CARE PRACTICE
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Dates
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Enumeration Date | 05/01/2020
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 13000 COTTONWOOD RD
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City | COTTONWOOD
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State | AL
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Zip | 36320-4280
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Country | US
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Telephone | 334-797-4787
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 509
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City | COTTONWOOD
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State | AL
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Zip | 36320-0509
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA CARLIELA JONES
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Credential | CRNP
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Telephone | 334-797-4787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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