MEDICARE: MY MEDICAL MAKEOVER

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	207Q00000X	Family Medicine Physician	31089	AL

General Provider Information

NPI Number	:	1912343914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY MEDICAL MAKEOVER

Provider Business Mailing Address
First Line	:	1847 COMMONS NORTH DR
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-3700
Country	:	US
Telephone Number	:	205-345-6272
Fax Number	:	205-345-1684

Provider Business Practice Location Address
First Line	:	1847 COMMONS NORTH DR
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-3700
Country	:	US
Telephone Number	:	205-345-6272
Fax Number	:	205-345-1684

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CAROLINE DAY
Credential	:	M.D.
Telephone Number	:	205-345-6272

Provider Enumeration Date	:	05/16/2013
Last Update Date	:	05/16/2013

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Directions to “MY MEDICAL MAKEOVER ” Practice Location

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