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General NPI Number Information
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NPI Number | 1942602412
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Entity Type | Organization
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Legal Business Name | MEDWEST CLINIC
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 7715 US HIGHWAY 72
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City | ATHENS
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State | AL
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Zip | 35611-8979
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Country | US
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Telephone | 256-729-9477
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Fax | 256-729-9464
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Provider Business Mailing Address
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Address Line | 7715 US HIGHWAY 72
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City | ATHENS
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State | AL
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Zip | 35611-8979
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Country | US
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Telephone | 256-729-9477
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Fax | 256-729-9464
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SEBRINA B HOLT
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Credential |
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Telephone | 256-216-9648
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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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