Organization Name: | IMMEDIATE FAMILY CLINIC |
NPI Number: | 1598165623 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN PERRY (PROVIDER) |
Mailing Address: | 627 Saraland Blvd S Saraland |
State: | AL US |
Postal Code: | 365713633 |
Phone Number: | 2516791988 |
Fax Number: | 2516799282 |
NPI Enumeration Date: | 08/26/2014 |
NPI Last Update Date: | 08/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R868142 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |