Provider Demographics
NPI:1134825003
Name:GLADSTONE PRIMARY CARE PC
Entity type:Organization
Organization Name:GLADSTONE PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:256-773-6017
Mailing Address - Street 1:301 PINE ST NW STE A
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-2339
Mailing Address - Country:US
Mailing Address - Phone:256-773-6017
Mailing Address - Fax:256-773-7834
Practice Address - Street 1:301 PINE ST NW STE A
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2339
Practice Address - Country:US
Practice Address - Phone:256-773-6017
Practice Address - Fax:256-773-7834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty