Organization
BEAVERTON FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL ETHAN BUTLER (PRACTICE MANAGER)
(256) 590-4137
Entity
Organization
Contact information
Practice address
12815 HIGHWAY 278, BEAVERTON, AL 35544-2954
(205) 606-1200
Mailing address
12815 HIGHWAY 278, BEAVERTON, AL 35544-2954
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/30/2023
Last updated
07/14/2023
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