Organization
MEDCENTER FAYETTE, LLC
Active
Parent organization
TUSCALOOSA MEDCENTER NORTH, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TUSCALOOSA MEDCENTER NORTH, PC
Authorized official
BETH KOHN (CREDENTIALING SPECIALIST)
(912) 756-2273
Entity
Organization
Contact information
Practice address
122 17TH CT NE, FAYETTE, AL 35555-1353
(205) 330-1707
(205) 333-0782
Mailing address
3909 MCFARLAND BLVD, NORTHPORT, AL 35476-2838
(205) 330-1707
(205) 333-0782
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12135
MD LICENSE
AL
Enumeration date
03/08/2016
Last updated
12/19/2024
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