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General NPI Number Information
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NPI Number | 1952472607
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Entity Type | Organization
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Legal Business Name | WETUMPKA FAMILY PRACTICE PA
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 73970 TALLASSEE HWY
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City | WETUMPKA
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State | AL
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Zip | 36092
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Country | US
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Telephone | 334-567-7850
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Fax | 334-567-7866
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Provider Business Mailing Address
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Address Line | 73970 TALLASSEE HWY
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City | WETUMPKA
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State | AL
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Zip | 36092
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Country | US
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Telephone | 334-567-7850
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Fax | 334-567-7866
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Authorized Official
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Title or Position | MEDICAL DIRECTOR PRESIDENT
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Name | DR. SPENCER J COLEMAN SR.
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Credential | MD
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Telephone | 334-567-7850
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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 | 14136
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License Number State | AL
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