MEDICARE: VETERANS WELLNESS CENTER OF ALABAMA LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	261QP2000X	Physical Therapy Clinic/Center
3	261QP2300X	Primary Care Clinic/Center
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	335E00000X	Prosthetic/Orthotic Supplier
6	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1568005056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETERANS WELLNESS CENTER OF ALABAMA LLC

Provider Business Mailing Address
First Line	:	PO BOX 240132
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36124-0132
Country	:	US
Telephone Number	:	443-902-8816
Fax Number	:	334-323-7148

Provider Business Practice Location Address
First Line	:	5911 MONTICELLO DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1940
Country	:	US
Telephone Number	:	334-676-2797
Fax Number	:	334-323-7148

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	DAVID GRAHAM
Credential	:
Telephone Number	:	334-676-2797

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/02/2024

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