Provider Demographics
NPI:1639488893
Name:ABUNDANT LIFE MEDICAL CARE, PC
Entity Type:Organization
Organization Name:ABUNDANT LIFE MEDICAL CARE, PC
Other - Org Name:MARLO E. PAUL, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLO
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-368-9390
Mailing Address - Street 1:P.O. BOX 9
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35464
Mailing Address - Country:US
Mailing Address - Phone:334-624-2553
Mailing Address - Fax:855-301-8116
Practice Address - Street 1:6228 COUNTY ROAD 28
Practice Address - Street 2:
Practice Address - City:SAWYERVILLE
Practice Address - State:AL
Practice Address - Zip Code:36776-2557
Practice Address - Country:US
Practice Address - Phone:334-624-2553
Practice Address - Fax:855-301-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty