Organization
PHYSICAL EXPRESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JADE LANE (CREDENTIALING MANAGER)
(334) 567-4311
Entity
Organization
Contact information
Practice address
4081 ALABAMA HWY 14, MILLBROOK, AL 36054
(334) 285-3222
(334) 285-6555
Mailing address
PO BOX 688, MILLBROOK, AL 36054-0014
(334) 285-3222
(334) 285-6555
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/16/2007
Last updated
03/20/2025
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