Provider Demographics
NPI:1952719551
Name:CALHOUN MEDICAL CLINIC INC.
Entity Type:Organization
Organization Name:CALHOUN MEDICAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WYNDOL
Authorized Official - Middle Name:SPAN
Authorized Official - Last Name:HAMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-294-7004
Mailing Address - Street 1:1700 CHRISTINE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-3812
Mailing Address - Country:US
Mailing Address - Phone:256-294-7004
Mailing Address - Fax:256-294-7005
Practice Address - Street 1:1700 CHRISTINE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3812
Practice Address - Country:US
Practice Address - Phone:256-294-7004
Practice Address - Fax:256-294-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-27
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9756261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care