MEDICARE: PELL CITY

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1730386137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELL CITY

Provider Business Mailing Address
First Line	:	1000 BRUCE ETHEREDGE PKWY
Second Line	:	SUITE 201
City	:	PELL CITY
State	:	AL
Zip	:	35128-3213
Country	:	US
Telephone Number	:	205-884-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 BRUCE ETHEREDGE PKWY
Second Line	:	SUITE 201
City	:	PELL CITY
State	:	AL
Zip	:	35128-3213
Country	:	US
Telephone Number	:	205-884-4440
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	DR. BOBBY HATHCOCK
Credential	:
Telephone Number	:	205-884-4440

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	08/22/2020

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Directions to “PELL CITY ” Practice Location

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