Organization
CULLMAN PRIMARY CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE D BLANKENSHIP (CREDENTIALING COORDINATOR)
(256) 739-0801
Entity
Organization
Contact information
Practice address
1800 AL HIGHWAY 157 STE 101, CULLMAN, AL 35058-1273
(256) 739-4131
(256) 739-6027
Mailing address
503 CLARK ST NE, CULLMAN, AL 35055-1921
(256) 739-0801
(256) 739-0027
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117960
—
AL
Enumeration date
05/17/2006
Last updated
06/15/2023
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