SAND MOUNTAIN INTERNAL MEDICINE AND GERIATRICS NPI 1861771792

NPI Information

SAND MOUNTAIN INTERNAL MEDICINE AND GERIATRICS is a primary care clinic center in Boaz, AL. SAND MOUNTAIN INTERNAL MEDICINE AND GERIATRICS NPI is 1861771792. The provider is registered as an organization entity type.

The provider's business location address is:

605A MEDICAL CENTER PKWY
BOAZ, AL
ZIP 35957-937
Phone: (256) 281-6192
Fax: (256) 281-6196

The provider's authorized official is Wendy Renee Gomez .
The authorized official title is Physician/president and has the following contact phone number (205) 542-2713.

The CLIA number assigned to this NPI record is 01D2025894 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/9/2011 and was last updated on 8/9/2011.

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:

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