MEDICARE: CHATOM PRIMARY CARE PC

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1326243270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATOM PRIMARY CARE PC

Provider Business Mailing Address
First Line	:	PO BOX 1237
Second Line	:
City	:	CHATOM
State	:	AL
Zip	:	36518-1237
Country	:	US
Telephone Number	:	251-847-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 5TH AVENUE
Second Line	:
City	:	MILLRY
State	:	AL
Zip	:	36558-0000
Country	:	US
Telephone Number	:	251-847-6262
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES S DONALD
Credential	:	M.D.
Telephone Number	:	251-847-6262

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	08/22/2020

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