MEDICARE: HOMETOWN FAMILY MEDICINE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	1124159	AL

General Provider Information

NPI Number	:	1013318070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMETOWN FAMILY MEDICINE, INC.

Provider Business Mailing Address
First Line	:	2846 MOODY PKWY
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-3328
Country	:	US
Telephone Number	:	205-640-1756
Fax Number	:	205-640-1796

Provider Business Practice Location Address
First Line	:	2846 MOODY PKWY
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-3328
Country	:	US
Telephone Number	:	205-640-1756
Fax Number	:	205-640-1796

Authorized Official
Title or Position	:	OWNER/NURSE PRACTITIONER
Name	:	KALA BLAKELY
Credential	:	DNP
Telephone Number	:	205-640-1756

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	03/23/2022

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