Organization
COOSA VALLEY SPORTS MEDICINE AND PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNIETH C MCCOLLOUGH M.D. (OWNER)
(256) 245-3201
Entity
Organization
Contact information
Practice address
209 W SPRING ST, SUITE 305, SYLACAUGA, AL 35150-2973
(256) 245-3201
(256) 245-4112
Mailing address
209 W SPRING ST, SUITE 305, SYLACAUGA, AL 35150-2973
(256) 245-3201
(256) 245-4112
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD.29754
AL
Other
Enumeration date
12/09/2013
Last updated
12/09/2013
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