Provider Demographics
NPI:1134273345
Name:4MD2 IN PATIENT PHYSICIAN SERVICES OF DECATUR LLC
Entity type:Organization
Organization Name:4MD2 IN PATIENT PHYSICIAN SERVICES OF DECATUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:DUWANE
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-999-6209
Mailing Address - Street 1:1028 HIGHLAND LAKES TRCE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6877
Mailing Address - Country:US
Mailing Address - Phone:205-999-6209
Mailing Address - Fax:205-408-1719
Practice Address - Street 1:1201 7TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3337
Practice Address - Country:US
Practice Address - Phone:256-341-2909
Practice Address - Fax:256-301-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty