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General NPI Number Information
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NPI Number | 1912486937
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Entity Type | Organization
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Legal Business Name | CEDAR STREET PRIMARY CARE INC.
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 220 CEDAR ST NW
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City | HARTSELLE
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State | AL
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Zip | 35640
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Country | US
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Telephone | 256-773-2260
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Fax |
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Provider Business Mailing Address
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Address Line | 214 HIGHWAY 31 NW
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City | HARTSELLE
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State | AL
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Zip | 35640-4445
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Country | US
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Telephone | 256-292-7410
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Fax | 256-502-9879
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEB STUART HORNSBY
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Credential | MD
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Telephone | 256-292-7410
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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 | 29015
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License Number State | AL
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