# MEDCENTER FAYETTE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TUSCALOOSA MEDCENTER NORTH, PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1235590001
- **Legal business name:** TUSCALOOSA MEDCENTER NORTH, PC
- **Authorized official:** BETH KOHN (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (912) 756-2273

## Contact information

- **Practice address:** 122 17TH CT NE, FAYETTE, AL 35555-1353
- **Practice address phone:** (205) 330-1707
- **Practice address fax:** (205) 333-0782
- **Mailing address:** 3909 MCFARLAND BLVD, NORTHPORT, AL 35476-2838
- **Mailing address phone:** (205) 330-1707
- **Mailing address fax:** (205) 333-0782

## Taxonomy

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

## Other

- **Enumeration date:** 03/08/2016
- **Last updated:** 12/19/2024