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General NPI Number Information
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NPI Number | 1912156878
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Entity Type | Organization
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Legal Business Name | CLARKE COUNTY FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 33650 HIGHWAY 43 STE 100
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City | THOMASVILLE
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State | AL
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Zip | 36784-3307
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Country | US
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Telephone | 334-636-0791
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Fax | 334-636-0602
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Provider Business Mailing Address
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Address Line | 33650 HIGHWAY 43 STE 100
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City | THOMASVILLE
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State | AL
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Zip | 36784-3307
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Country | US
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Telephone | 334-636-0791
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Fax | 334-636-0602
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Authorized Official
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Title or Position | COO
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Name | LISA SIMS
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Credential | RD
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Telephone | 334-636-4431
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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 |
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License Number State |
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