Provider Demographics
NPI:1316401557
Name:J PAUL JONES HOSPITAL PRIMARY CARE CLINIC
Entity Type:Organization
Organization Name:J PAUL JONES HOSPITAL PRIMARY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-682-4131
Mailing Address - Street 1:317 MCWILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36726-1610
Mailing Address - Country:US
Mailing Address - Phone:334-682-4131
Mailing Address - Fax:334-682-0361
Practice Address - Street 1:321 WHISKEY RUN RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AL
Practice Address - Zip Code:36726-2303
Practice Address - Country:US
Practice Address - Phone:334-682-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J. PAUL JONES HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care