Provider Demographics
NPI:1326243270
Name:CHATOM PRIMARY CARE PC
Entity Type:Organization
Organization Name:CHATOM PRIMARY CARE PC
Other - Org Name:MILLRY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-847-6262
Mailing Address - Street 1:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:CHATOM
Mailing Address - State:AL
Mailing Address - Zip Code:36518-1237
Mailing Address - Country:US
Mailing Address - Phone:251-847-6262
Mailing Address - Fax:
Practice Address - Street 1:75 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:MILLRY
Practice Address - State:AL
Practice Address - Zip Code:36558-0000
Practice Address - Country:US
Practice Address - Phone:251-847-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health