Organization
CLINIC652 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WARREN ALEXANDER O'MEARA-DATES (MEMBER/CHIEF EXECUTIVE OFFICER)
(256) 418-4005
Entity
Organization
Contact information
Practice address
2600 E MEIGHAN BLVD, GADSDEN, AL 35903-1924
(256) 418-4005
(256) 399-0102
Mailing address
417 TAYLOR ST, GADSDEN, AL 35903-2557
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
01/25/2022
Last updated
01/25/2022
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