Provider Demographics
NPI:1912343914
Name:MY MEDICAL MAKEOVER
Entity Type:Organization
Organization Name:MY MEDICAL MAKEOVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-345-6272
Mailing Address - Street 1:1847 COMMONS NORTH DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-3700
Mailing Address - Country:US
Mailing Address - Phone:205-345-6272
Mailing Address - Fax:205-345-1684
Practice Address - Street 1:1847 COMMONS NORTH DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-3700
Practice Address - Country:US
Practice Address - Phone:205-345-6272
Practice Address - Fax:205-345-1684
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PRACTICE AT THE FALLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty