Organization
SOUTHERN DIVINE FAMILY MEDICAL CENTER LLC
Active
Other names
United Doctors Family Medical Center - Altoona
Organization subpart
No
Provider details
NPI number
Authorized official
ENRICO D GASPAR MD (OWNER)
(256) 840-8181
Entity
Organization
Contact information
Practice address
7130 6TH AVE, ALTOONA, AL 35952-9052
(205) 589-1092
(205) 589-1096
Mailing address
PO BOX 35, ALTOONA, AL 35952-0035
(205) 589-1092
(205) 589-1096
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
01/21/2020
Last updated
04/09/2022
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