Provider Demographics
NPI:1750465498
Name:THE SHOALS CLINIC PC
Entity Type:Organization
Organization Name:THE SHOALS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRIPIREDDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-718-0099
Mailing Address - Street 1:2115 CLOYD BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-7512
Mailing Address - Country:US
Mailing Address - Phone:256-718-0099
Mailing Address - Fax:256-718-0006
Practice Address - Street 1:2115 CLOYD BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-7512
Practice Address - Country:US
Practice Address - Phone:256-718-0099
Practice Address - Fax:256-718-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G857Medicare ID - Type Unspecified