Provider Demographics
NPI:1891316758
Name:MODERN HEALTH FAMILY CARE PRACTICE
Entity Type:Organization
Organization Name:MODERN HEALTH FAMILY CARE PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:CARLIELA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-797-4787
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:36320-0509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13000 COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AL
Practice Address - Zip Code:36320-4280
Practice Address - Country:US
Practice Address - Phone:334-797-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care