| Fmc Medical Clinic Millport | |
|
13530 Highway 96 Millport AL 35576-2522 | |
| (205) 662-3207 | |
| (205) 333-4660 |
| Full Name | Fmc Medical Clinic Millport |
|---|---|
| Speciality | Family Medicine |
| Location | 13530 Highway 96, Millport, Alabama |
| Authorized Official Name and Position | Ryan Campbell (DIRECTOR OF PHYSICIAN SERVICE) |
| Authorized Official Contact | 2057596165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fmc Medical Clinic Millport 1820 Rice Mine Rd N Suite 200 Tuscaloosa AL 35406-3281 Ph: (205) 333-4661 | Fmc Medical Clinic Millport 13530 Highway 96 Millport AL 35576-2522 Ph: (205) 662-3207 |
| NPI Number | 1063871184 |
|---|---|
| Provider Enumeration Date | 02/17/2016 |
| Last Update Date | 06/08/2016 |
| Medicare PECOS PAC ID | 8820395809 |
|---|---|
| Medicare Enrollment ID | O20160318002095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063871184 | NPI | - | NPPES |
| 183355 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Faith Williams Jolly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306122106 PECOS PAC ID: 7416118559 Enrollment ID: I20120417000112 |
| Provider Name | Cortney L Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154795177 PECOS PAC ID: 7416251764 Enrollment ID: I20160205001375 |
| Provider Name | Lindsay Ashby Kemp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992120158 PECOS PAC ID: 1355648239 Enrollment ID: I20160318002170 |
| Provider Name | Hannah L Livingston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730593625 PECOS PAC ID: 5496034563 Enrollment ID: I20161111001673 |
| Provider Name | Crystal A Mccoy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992253090 PECOS PAC ID: 2062795446 Enrollment ID: I20170208003065 |
| Provider Name | Dakota Acton-jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790167864 PECOS PAC ID: 1153638192 Enrollment ID: I20181017002326 |
| Provider Name | Kristin Moudry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720568363 PECOS PAC ID: 6002150711 Enrollment ID: I20181206003578 |
Millport Fam Practice Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13530 Highway 96, Millport, AL 35576 Phone: 205-662-5784 Fax: 205-662-5786 | |
Millport Family Practice Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13530 Highway 96, Millport, AL 35576 Phone: 205-662-5784 |