Provider Demographics
NPI:1033225818
Name:CLARKE COUNTY FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:CLARKE COUNTY FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-636-5311
Mailing Address - Street 1:33650 HIGHWAY 43
Mailing Address - Street 2:SUITE 300
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-3336
Mailing Address - Country:US
Mailing Address - Phone:334-636-0757
Mailing Address - Fax:334-636-0760
Practice Address - Street 1:33650 HIGHWAY 43
Practice Address - Street 2:SUITE 300
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3336
Practice Address - Country:US
Practice Address - Phone:334-636-0757
Practice Address - Fax:334-636-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00026983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-35275OtherBCBS OF ALABAMA
ALG23040Medicare UPIN