Provider Demographics
NPI:1558859157
Name:FLINT RIVER FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:FLINT RIVER FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-469-6487
Mailing Address - Street 1:5575 HIGHWAY 431 S STE 104
Mailing Address - Street 2:
Mailing Address - City:BROWNSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35741-9755
Mailing Address - Country:US
Mailing Address - Phone:256-469-6487
Mailing Address - Fax:256-585-3852
Practice Address - Street 1:5575 HIGHWAY 431 S STE 104
Practice Address - Street 2:
Practice Address - City:BROWNSBORO
Practice Address - State:AL
Practice Address - Zip Code:35741-9755
Practice Address - Country:US
Practice Address - Phone:256-469-6487
Practice Address - Fax:256-585-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-29
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care