Provider Demographics
NPI:1700238508
Name:MEDICAL EAST OF DECATUR INC
Entity Type:Organization
Organization Name:MEDICAL EAST OF DECATUR INC
Other - Org Name:SOMERVILLE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-432-2822
Mailing Address - Street 1:2941 POINT MALLARD PKWY SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-5716
Mailing Address - Country:US
Mailing Address - Phone:256-432-2822
Mailing Address - Fax:256-432-2825
Practice Address - Street 1:4166 HIGHWAY 36 E
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:AL
Practice Address - Zip Code:35670-5803
Practice Address - Country:US
Practice Address - Phone:256-778-7172
Practice Address - Fax:256-778-8910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL EAST OF DECATUR INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-06
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty