Provider Demographics
NPI:1912068354
Name:GARY ALAN CALHOUN FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:GARY ALAN CALHOUN FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-505-6826
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:P O BOX 668
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0012
Mailing Address - Country:US
Mailing Address - Phone:256-505-6826
Mailing Address - Fax:256-582-1100
Practice Address - Street 1:227 BRIDLE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-9285
Practice Address - Country:US
Practice Address - Phone:256-505-6826
Practice Address - Fax:256-582-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI415OtherMEDICARE GROUP
AL051501161Medicare Oscar/Certification
ALE45729Medicare PIN