Provider Demographics
NPI:1194025346
Name:MARBLE CITY FAMILY CARE AND OBSTETRICS, PC
Entity Type:Organization
Organization Name:MARBLE CITY FAMILY CARE AND OBSTETRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-245-6700
Mailing Address - Street 1:11 N NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2451
Mailing Address - Country:US
Mailing Address - Phone:256-245-6700
Mailing Address - Fax:256-245-6002
Practice Address - Street 1:11 N NORTON AVE
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2451
Practice Address - Country:US
Practice Address - Phone:256-245-6700
Practice Address - Fax:256-245-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI42284Medicare UPIN