Provider Demographics
NPI:1598750762
Name:PHYSICIANS CARE OF THOMASVILLE LLC
Entity Type:Organization
Organization Name:PHYSICIANS CARE OF THOMASVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HUEY
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-636-5311
Mailing Address - Street 1:33621 HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-3347
Mailing Address - Country:US
Mailing Address - Phone:334-636-5311
Mailing Address - Fax:334-636-2280
Practice Address - Street 1:33621 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-3347
Practice Address - Country:US
Practice Address - Phone:334-636-5311
Practice Address - Fax:334-636-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty