Provider Demographics
NPI:1578645396
Name:HAZEL GREEN PRIMARY CARE
Entity Type:Organization
Organization Name:HAZEL GREEN PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICIANS NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-265-7791
Mailing Address - Street 1:13596 HIGHWAY 231 431 N
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750-8617
Mailing Address - Country:US
Mailing Address - Phone:256-829-0610
Mailing Address - Fax:256-829-1371
Practice Address - Street 1:13596 HIGHWAY 231 431 N
Practice Address - Street 2:SUITE 4
Practice Address - City:HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:35750-8617
Practice Address - Country:US
Practice Address - Phone:256-829-0610
Practice Address - Fax:256-829-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty