Provider Demographics
NPI:1003006289
Name:WADDELL CENTER FAMILY MEDICINE
Entity Type:Organization
Organization Name:WADDELL CENTER FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RANDY
Authorized Official - Last Name:COMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-233-9172
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35612-0999
Mailing Address - Country:US
Mailing Address - Phone:256-216-9777
Mailing Address - Fax:
Practice Address - Street 1:902 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2438
Practice Address - Country:US
Practice Address - Phone:256-216-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty