Provider Demographics
NPI:1881646743
Name:SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH
Entity Type:Organization
Organization Name:SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH
Other - Org Name:PRIMARY HEALTHCARE OF TALLADEGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-741-7340
Mailing Address - Street 1:230 E 10TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5784
Mailing Address - Country:US
Mailing Address - Phone:256-741-7340
Mailing Address - Fax:
Practice Address - Street 1:223 HAYNES ST
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2559
Practice Address - Country:US
Practice Address - Phone:256-315-4950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health