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General NPI Number Information
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NPI Number | 1891897948
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Entity Type | Organization
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Legal Business Name | TRICOUNTY FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 12/16/2008
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Provider Practice Location Address
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Address Line | 149 CHESTNUT ST
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City | ROANOKE
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State | AL
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Zip | 36274-1301
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Country | US
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Telephone | 334-863-5484
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Fax | 334-863-5481
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Provider Business Mailing Address
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Address Line | 149 CHESTNUT ST
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City | ROANOKE
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State | AL
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Zip | 36274-1301
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Country | US
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Telephone | 334-863-5484
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Fax | 334-863-5481
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ABAYOMI G OSHINOWO
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Credential | MD
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Telephone | 334-863-5484
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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 | 20466
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License Number State | AL
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