Provider Demographics
NPI:1154458982
Name:SOUTHERN FAMILY HEALTH
Entity Type:Organization
Organization Name:SOUTHERN FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-669-4884
Mailing Address - Street 1:201 HIGHWAY 25 E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051-9373
Mailing Address - Country:US
Mailing Address - Phone:205-669-4884
Mailing Address - Fax:205-669-4883
Practice Address - Street 1:201 HIGHWAY 25 E
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-9373
Practice Address - Country:US
Practice Address - Phone:205-669-4884
Practice Address - Fax:205-669-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health