Provider Demographics
NPI:1669641726
Name:KOUNS MEDICAL CLINIC,LLC
Entity Type:Organization
Organization Name:KOUNS MEDICAL CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:KOUNS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-648-2660
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:SUMITON
Mailing Address - State:AL
Mailing Address - Zip Code:35148-0656
Mailing Address - Country:US
Mailing Address - Phone:205-648-2660
Mailing Address - Fax:205-648-2886
Practice Address - Street 1:1190 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148-4827
Practice Address - Country:US
Practice Address - Phone:205-648-2660
Practice Address - Fax:205-648-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALA93599Medicare UPIN