Provider Demographics
NPI:1467497875
Name:SOUTH SHELBY FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:SOUTH SHELBY FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:KANATANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-492-9313
Mailing Address - Street 1:PO BOX 584
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-2045
Mailing Address - Country:US
Mailing Address - Phone:205-492-9313
Mailing Address - Fax:
Practice Address - Street 1:1022 1ST ST N
Practice Address - Street 2:SUITE 302
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8706
Practice Address - Country:US
Practice Address - Phone:205-663-4009
Practice Address - Fax:205-663-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty