Provider Demographics
NPI:1922786706
Name:SHOAL'S FAMILY PRACTICE-URGENT CARE LLC
Entity Type:Organization
Organization Name:SHOAL'S FAMILY PRACTICE-URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-394-8842
Mailing Address - Street 1:1110 E 6TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-3957
Mailing Address - Country:US
Mailing Address - Phone:256-397-8842
Mailing Address - Fax:256-246-9764
Practice Address - Street 1:1110 E 6TH ST STE D
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-3957
Practice Address - Country:US
Practice Address - Phone:256-397-8842
Practice Address - Fax:256-246-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty