| Organization Name: | DR KEITH DISMUKES L.L.C. |
| NPI Number: | 1801161138 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURI ANNE CAMERON (ASST. OFFICE MANAGER) |
| Mailing Address: | 202 Us Highway 80 E Demopolis |
| State: | AL US |
| Postal Code: | 367323622 |
| Phone Number: | 3342890499 |
| Fax Number: | 3342893013 |
| NPI Enumeration Date: | 03/20/2012 |
| NPI Last Update Date: | 03/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | AD7121724 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |