Organization
PRIMARY CARE INTERNISTS OF MONTGOMERY, P.C.
Active
Organization
PRIMARY CARE INTERNISTS OF MONTGOMERY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLA SEWELL CMPE (ADMINISTRATOR)
(334) 262-0342
Entity
Organization
Contact information
Practice address
1722 PINE ST, SUITE 309, MONTGOMERY, AL 36106-1103
(334) 262-0342
(334) 262-0390
Mailing address
1722 PINE ST, SUITE 309, MONTGOMERY, AL 36106-1103
(334) 262-0342
(334) 262-0390
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01D0671060
CLIA CERTIFICATE #
AL
Enumeration date
11/02/2005
Last updated
06/16/2015
Update your record
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