1700365756 NPI number — SCOTTSBORO FAMILY PHYSICIANS PC

Table of content: (NPI 1700365756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700365756 NPI number — SCOTTSBORO FAMILY PHYSICIANS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTTSBORO FAMILY PHYSICIANS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700365756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1302 S BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSBORO
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35768-2605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-218-4080
Provider Business Mailing Address Fax Number:
256-218-3147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42950 US HIGHWAY 72 STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEVENSON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35772-5459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-548-3104
Provider Business Practice Location Address Fax Number:
256-548-3106
Provider Enumeration Date:
08/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
COOKE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
256-218-4080

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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