# IVY CREEK FAMILY CARE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1972850741
- **Authorized official:** JAMES GORDON FAULK (CEO)
- **Authorized official phone:** (334) 361-7316

## Contact information

- **Practice address:** 201 S WASHINGTON ST, AUTAUGAVILLE, AL 36003-2535
- **Practice address phone:** (334) 361-7316
- **Practice address fax:** (334) 361-7858
- **Mailing address:** PO BOX 490, AUTAUGAVILLE, AL 36003-0490
- **Mailing address phone:** (334) 361-7316
- **Mailing address fax:** (334) 361-7858

## Taxonomy

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

## Other

- **Enumeration date:** 08/10/2012
- **Last updated:** 09/28/2012