Organization
SOUTHERN FAMILY PRACTICE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CECILIA RENEE ROBINSON CRNP (NURSE PRACTITIONER)
(334) 684-9400
Entity
Organization
Contact information
Practice address
100 W LAKE PROFESSIONAL PARK STE 1, GENEVA, AL 36340-1200
(334) 684-9400
(334) 684-6262
Mailing address
100 W LAKE PROFESSIONAL PARK STE 1, GENEVA, AL 36340-1200
(334) 684-9400
(334) 684-6262
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-074572
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051593913
BLUECROSS BLUESHIELD OF AL.
AL
05
—
108157
—
AL
01
—
510G700444
MEDICARE OF ALABAMA
AL
Enumeration date
10/09/2008
Last updated
03/23/2009
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