# MILLPORT FAM PRACTICE CLINIC, LLC

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

## Provider details

- **NPI number:** 1265561328
- **Authorized official:** DR. ROBERT E SWANSON DNP, CRNP (MANAGING PARTNER)
- **Authorized official phone:** (205) 662-5784

## Contact information

- **Practice address:** 13530 HIGHWAY 96, MILLPORT, AL 35576-2522
- **Practice address phone:** (205) 662-5784
- **Practice address fax:** (205) 662-5786
- **Mailing address:** 13530 HIGHWAY 96, MILLPORT, AL 35576-2522
- **Mailing address phone:** (205) 662-5784
- **Mailing address fax:** (205) 662-5786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 05/28/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 541003936 | — | AL |