Provider Demographics
NPI:1376211011
Name:PHYSICIANS CARE OF CLARKE
Entity Type:Organization
Organization Name:PHYSICIANS CARE OF CLARKE
Other - Org Name:AKA FULTON FAMILY MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FARRELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-636-5311
Mailing Address - Street 1:24B CAMDEN BYP
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36726-1770
Mailing Address - Country:US
Mailing Address - Phone:334-882-1919
Mailing Address - Fax:
Practice Address - Street 1:218 MAIN ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:AL
Practice Address - Zip Code:36446
Practice Address - Country:US
Practice Address - Phone:334-636-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)