Provider Demographics
NPI:1457843708
Name:JMAC MED LLC
Entity Type:Organization
Organization Name:JMAC MED LLC
Other - Org Name:WILSON DAM CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-856-2424
Mailing Address - Street 1:4951 WILSON DAM RD
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-9141
Mailing Address - Country:US
Mailing Address - Phone:256-856-2424
Mailing Address - Fax:
Practice Address - Street 1:4951 WILSON DAM RD
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-9141
Practice Address - Country:US
Practice Address - Phone:256-856-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care