Provider Demographics
NPI:1700365756
Name:SCOTTSBORO FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:SCOTTSBORO FAMILY PHYSICIANS PC
Other - Org Name:STEVENSON FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:COOKE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-218-4080
Mailing Address - Street 1:1302 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2605
Mailing Address - Country:US
Mailing Address - Phone:256-218-4080
Mailing Address - Fax:256-218-3147
Practice Address - Street 1:79 BANK ST
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:AL
Practice Address - Zip Code:35772-3781
Practice Address - Country:US
Practice Address - Phone:256-548-3104
Practice Address - Fax:256-548-3106
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTTSBORO FAMILY PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-10
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care