Provider Demographics
NPI:1437135209
Name:ANNISTON FAMILY PRACTICE P.C.
Entity Type:Organization
Organization Name:ANNISTON FAMILY PRACTICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:W
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-237-8527
Mailing Address - Street 1:400 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5754
Mailing Address - Country:US
Mailing Address - Phone:256-237-8527
Mailing Address - Fax:256-237-0208
Practice Address - Street 1:400 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5754
Practice Address - Country:US
Practice Address - Phone:256-237-8527
Practice Address - Fax:256-237-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization