Provider Demographics
NPI:1467741744
Name:TALLADEGA FAMILY HEALTH CENTER LLC
Entity Type:Organization
Organization Name:TALLADEGA FAMILY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-230-1116
Mailing Address - Street 1:108 SANDERS ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2459
Mailing Address - Country:US
Mailing Address - Phone:256-230-1116
Mailing Address - Fax:256-230-1156
Practice Address - Street 1:108 SANDERS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2459
Practice Address - Country:US
Practice Address - Phone:256-230-1116
Practice Address - Fax:256-230-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15022261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service