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General NPI Number Information
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NPI Number | 1962511600
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Entity Type | Organization
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Legal Business Name | SOUTHERN FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 2367 US HWY 431
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City | BOAZ
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State | AL
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Zip | 35957
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Country | US
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Telephone | 256-840-4571
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Fax | 256-840-4534
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Provider Business Mailing Address
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Address Line | PO BOX 1290
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City | BOAZ
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State | AL
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Zip | 35957
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Country | US
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Telephone | 256-840-4571
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Fax | 256-840-4534
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA L CLIFTON
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Credential | MD
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Telephone | 256-891-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0025564
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00025564
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License Number State | AL
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