# BROOKWOOD PRIMARY CARE- GRAND RIVER, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Brookwood Primary Care- Grand River, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053794354
- **Authorized official:** MR. MICHAEL KYLE BURTNETT (SVP, OUTPATIENT SERVICES, TENET)
- **Authorized official phone:** (469) 893-2902

## Contact information

- **Practice address:** 1115 PAYTON WAY., SUITE 111, LEEDS, AL 35094
- **Practice address phone:** (205) 352-1175
- **Mailing address:** 4902 VALLEYDALE RD, BIRMINGHAM, AL 35242-4613
- **Mailing address phone:** (205) 980-8099
- **Mailing address fax:** (205) 980-2606

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 07/06/2015
- **Last updated:** 05/26/2016