# FULTONDALE URGENT CARE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063804052
- **Authorized official:** DOUG RANDALL (COO)
- **Authorized official phone:** (205) 841-2844

## Contact information

- **Practice address:** 339 WALKER CHAPEL PLZ, SUITE 115, FULTONDALE, AL 35068-3401
- **Practice address phone:** (205) 841-2844
- **Mailing address:** 339 WALKER CHAPEL PLZ, SUITE 115, FULTONDALE, AL 35068-3401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/27/2015
- **Last updated:** 03/02/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0CXJ1 | BCBS | AL |
| 01 | — | 1659697696 | TRICARE SOUTH | AL |
| 05 | — | 169110 | — | AL |
| 01 | — | 615236400 | DOL | — |
| 01 | — | DQ4012 | RRMC | AL |