Organization
SOUTHERN GRACE MEDICAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY GREGORY WINN CRNP, NP-C (FAMILY NURSE PRACTITIONER / OWNER)
(256) 797-4118
Entity
Organization
Contact information
Practice address
500 GOVERNORS DR SW, HUNTSVILLE, AL 35801-5126
(256) 797-4118
Mailing address
1606 MOONTOWN RD, BROWNSBORO, AL 35741-9493
(256) 776-3850
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-159682
ALABAMA BOARD OF NURSING, RN LICENSE NUMBER
AL
01
—
23529
ALABAMA BOARD OF MEDICAL EXAMINERS
AL
01
—
8499
ALABAMA BOARD OF NURSING, RX NUMBER
AL
Enumeration date
04/23/2020
Last updated
04/23/2020
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