SOUTHERN GRACE MEDICAL CARE LLC NPI 1649890211

NPI Information

NPI: 1649890211
Provider Name: SOUTHERN GRACE MEDICAL CARE, LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 01D2215566

Address:
500 GOVERNORS DR SW
HUNTSVILLE, AL
ZIP 35801
Phone: (256) 797-4118
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SOUTHERN GRACE MEDICAL CARE, LLC is a primary care clinic center in Huntsville, AL. SOUTHERN GRACE MEDICAL CARE, LLC NPI is 1649890211. The provider is registered as an organization entity type.

The provider's business location address is:

500 GOVERNORS DR SW
HUNTSVILLE, AL
ZIP 35801-126
Phone: (256) 797-4118

The provider's authorized official is Jimmy Gregory Winn .
The authorized official title is Family Nurse Practitioner / Owner and has the following contact phone number (256) 797-4118.

The CLIA number assigned to this NPI record is 01D2215566 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/23/2020 and was last updated on 4/23/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	23529	OTHER	ALABAMA	ALABAMA BOARD OF MEDICAL EXAMINERS
2	8499	OTHER	ALABAMA	ALABAMA BOARD OF NURSING, RX NUMBER
3	1-159682	OTHER	ALABAMA	ALABAMA BOARD OF NURSING, RN LICENSE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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