Organization
LODEWICK DIABETES CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTE CRAWFORD (OFFICE MANAGER)
(205) 747-8991
Entity
Organization
Contact information
Practice address
3918 MONTCLAIR RD STE 217, MOUNTAIN BRK, AL 35213-2418
(205) 933-7881
(205) 785-2864
Mailing address
3918 MONTCLAIR RD STE 217, MOUNTAIN BRK, AL 35213-2418
(205) 933-7881
(205) 785-2864
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
00015124
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0051078865
BLUE CROSS BLUE SHIELD
AL
05
—
529804240
—
AL
01
—
78865
AETNA HEALTH
AL
Enumeration date
06/29/2006
Last updated
06/07/2012
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