Provider Demographics
NPI:1114118064
Name:COMMUNITY MEDICAL ARTS CENTER
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL ARTS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-283-3111
Mailing Address - Street 1:875 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1234
Mailing Address - Country:US
Mailing Address - Phone:334-283-3111
Mailing Address - Fax:334-283-3156
Practice Address - Street 1:875 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1234
Practice Address - Country:US
Practice Address - Phone:334-283-3111
Practice Address - Fax:334-283-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty