# CULLMAN COUNTY MEDICAL CLINIC INC

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

## Provider details

- **NPI number:** 1609879220
- **Authorized official:** MRS. SHANA JOCHUM HICE (DIRECTOR, PHYSICIAN PRACTICES)
- **Authorized official phone:** (256) 736-5328

## Contact information

- **Practice address:** 1910 CHEROKEE AVE SW, CULLMAN, AL 35055-5502
- **Practice address phone:** (256) 739-3500
- **Practice address fax:** (256) 736-1093
- **Mailing address:** 1910 CHEROKEE AVE. SW, CULLMAN, AL 35055
- **Mailing address phone:** (256) 739-3500
- **Mailing address fax:** (256) 775-6119

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 208M00000X | Hospitalist Physician | — | NULL | — |
| 208M00000X | Hospitalist Physician | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 05/27/2005
- **Last updated:** 08/04/2008