Organization
SOUTH ALABAMA MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIDGOT PETERS (DIRECTOR)
(251) 445-7618
Entity
Organization
Contact information
Practice address
10075 GRAND BAY WILMER RD S, GRAND BAY, AL 36541-5003
(251) 865-1852
(251) 865-1854
Mailing address
10075 GRAND BAY WILMER RD S, GRAND BAY, AL 36541-5003
(251) 865-1852
(251) 865-1854
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
1-072232
AL
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
AL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129323
—
AL
01
—
140171
RURAL HEALTH MEDICAID
AL
Enumeration date
04/21/2011
Last updated
08/29/2024
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