Organization
EXTENDED FAMILY MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELIA DENIESE BLACKMON CRNP (MEDICAL DIRECTOR)
(251) 438-7170
Entity
Organization
Contact information
Practice address
108 N CATHERINE ST, SUITE A, MOBILE, AL 36604-1304
(251) 438-7170
(251) 438-7173
Mailing address
108 N CATHERINE ST, SUITE A, MOBILE, AL 36604-1304
(251) 438-7170
(251) 438-7173
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
1-073404
AL
Other
Enumeration date
02/14/2007
Last updated
03/19/2025
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