Organization
MENTORUP LIFE LAB & CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLORY KATE JOHNSON MD (MEDICAL DIRECTOR)
(205) 771-2261
Entity
Organization
Contact information
Practice address
535 JACK WARNER PKWY NE STE G2, TUSCALOOSA, AL 35404-5715
(205) 771-2261
Mailing address
4202 20TH ST NE, TUSCALOOSA, AL 35404-1502
(205) 771-2261
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
05/23/2023
Last updated
05/23/2023
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