# FMC MEDICAL CLINIC MILLPORT

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

## Provider details

- **NPI number:** 1063871184
- **Authorized official:** MR. RYAN CAMPBELL (DIRECTOR OF PHYSICIAN SERVICE)
- **Authorized official phone:** (205) 759-6165

## Contact information

- **Practice address:** 13530 HIGHWAY 96, MILLPORT, AL 35576-2522
- **Practice address phone:** (205) 662-3207
- **Practice address fax:** (205) 333-4660
- **Mailing address:** 1820 RICE MINE RD N, SUITE 200, TUSCALOOSA, AL 35406-3281
- **Mailing address phone:** (205) 333-4661
- **Mailing address fax:** (205) 333-4660

## Taxonomy

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

## Other

- **Enumeration date:** 02/17/2016
- **Last updated:** 06/08/2016