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Organization
IVY CREEK FAMILY CARE OF LAKE MARTIN
Active
Organization
IVY CREEK FAMILY CARE OF LAKE MARTIN
Active
Other names
IVY CREEK URGENT CARE
Organization subpart
No
Provider details
NPI number
Authorized official
JADE LANE (CREDENTIALING MANAGER)
(334) 567-4311
Entity
Organization
Contact information
Practice address
5958 HIGHWAY 49 S UNIT K, DADEVILLE, AL 36853-6771
(256) 825-7821
Mailing address
PO BOX 130, WETUMPKA, AL 36092-0003
(334) 514-3821
(334) 514-3686
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
NULL
Other
Enumeration date
01/31/2023
Last updated
03/20/2025
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