Provider Demographics
NPI:1295828036
Name:JACKSON COUNTY FAMILY CARE CLINIC
Entity Type:Organization
Organization Name:JACKSON COUNTY FAMILY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HARDIN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-259-5537
Mailing Address - Street 1:508 HARLEY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-4294
Mailing Address - Country:US
Mailing Address - Phone:256-259-5537
Mailing Address - Fax:256-259-3189
Practice Address - Street 1:508 HARLEY ST
Practice Address - Street 2:SUITE C
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4294
Practice Address - Country:US
Practice Address - Phone:256-259-5537
Practice Address - Fax:256-259-3189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty