Provider Demographics
NPI:1508332446
Name:PICKENS COUNTY PRIMARY CARE, P.C
Entity Type:Organization
Organization Name:PICKENS COUNTY PRIMARY CARE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-792-6701
Mailing Address - Street 1:108 4TH AVE SW STE A
Mailing Address - Street 2:
Mailing Address - City:REFORM
Mailing Address - State:AL
Mailing Address - Zip Code:35481-8018
Mailing Address - Country:US
Mailing Address - Phone:205-375-6251
Mailing Address - Fax:205-375-9064
Practice Address - Street 1:815 7TH AVE SW
Practice Address - Street 2:
Practice Address - City:REFORM
Practice Address - State:AL
Practice Address - Zip Code:35481
Practice Address - Country:US
Practice Address - Phone:205-375-2438
Practice Address - Fax:205-375-2439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PICKENS COUNTY PRIMARY CARE, P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-18
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty