Provider Demographics
NPI:1457549438
Name:COMPLETE FAMILY CARE MD PC
Entity Type:Organization
Organization Name:COMPLETE FAMILY CARE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:NIXON
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-974-9216
Mailing Address - Street 1:94 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1256
Mailing Address - Country:US
Mailing Address - Phone:256-974-9216
Mailing Address - Fax:256-974-8211
Practice Address - Street 1:94 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1256
Practice Address - Country:US
Practice Address - Phone:256-974-9216
Practice Address - Fax:256-974-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012662173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC72273Medicare UPIN