# IVY CREEK FAMILY CARE OF LAKE MARTIN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** IVY CREEK URGENT CARE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609572890
- **Authorized official:** JADE LANE (CREDENTIALING MANAGER)
- **Authorized official phone:** (334) 567-4311

## Contact information

- **Practice address:** 5958 HIGHWAY 49 S UNIT K, DADEVILLE, AL 36853-6771
- **Practice address phone:** (256) 825-7821
- **Mailing address:** PO BOX 130, WETUMPKA, AL 36092-0003
- **Mailing address phone:** (334) 514-3821
- **Mailing address fax:** (334) 514-3686

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/31/2023
- **Last updated:** 03/20/2025