Provider Demographics
NPI:1225308059
Name:GILMER URGENT CARE
Entity Type:Organization
Organization Name:GILMER URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:B
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-259-3991
Mailing Address - Street 1:417 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ENSLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35218-1601
Mailing Address - Country:US
Mailing Address - Phone:205-259-3991
Mailing Address - Fax:205-383-1574
Practice Address - Street 1:100 GILBERT DR
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8867
Practice Address - Country:US
Practice Address - Phone:205-259-3991
Practice Address - Fax:205-383-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty