Provider Demographics
NPI:1699840827
Name:LONNIE N. ALBIN, M.D., FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:LONNIE N. ALBIN, M.D., FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-259-5550
Mailing Address - Street 1:507 HARLEY STREET
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768
Mailing Address - Country:US
Mailing Address - Phone:256-259-5550
Mailing Address - Fax:259-256-5552
Practice Address - Street 1:507 HARLEY STREET
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768
Practice Address - Country:US
Practice Address - Phone:256-259-5550
Practice Address - Fax:259-256-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529918970Medicaid
AL051517783Medicaid
ALJ584Medicare ID - Type UnspecifiedFACILITY NUMBER
AL529918970Medicaid
AL051517783ALBMedicare PIN