Provider Demographics
NPI:1790810950
Name:COMPLETE FAMILY PRACTICE
Entity Type:Organization
Organization Name:COMPLETE FAMILY PRACTICE
Other - Org Name:ASC OCCUPATIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAGEITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-737-9416
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-0638
Mailing Address - Country:US
Mailing Address - Phone:256-737-9416
Mailing Address - Fax:256-736-5684
Practice Address - Street 1:1908 CHEROKEE AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5502
Practice Address - Country:US
Practice Address - Phone:256-736-1460
Practice Address - Fax:256-736-1458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000181842083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1629093638OtherNPI
1235175886OtherNPI
1629093638OtherNPI
438170475OtherEIN
1235175886OtherNPI
F85759Medicare UPIN