Provider Demographics
NPI:1679894190
Name:ETOWAH FAMILY MEDICAL PC
Entity Type:Organization
Organization Name:ETOWAH FAMILY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:2565-546-4868
Mailing Address - Street 1:303 BAY ST
Mailing Address - Street 2:STE 301
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5265
Mailing Address - Country:US
Mailing Address - Phone:256-546-4868
Mailing Address - Fax:256-546-4967
Practice Address - Street 1:303 BAY ST
Practice Address - Street 2:STE 301
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5265
Practice Address - Country:US
Practice Address - Phone:256-546-4868
Practice Address - Fax:256-546-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD28124207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty