Mentorup Life Lab & Clinic

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MENTORUP LIFE LAB & CLINIC

Practice address

535 Jack Warner Pkwy NE Ste G2
Tuscaloosa, AL 35404-5715

Phone

(205) 771-2261

NPI assigned

May 23, 2023

Last updated

May 23, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ellory Kate Johnson, MDNPI 1467144949

Title

Medical Director

Phone

(205) 771-2261

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ellory Kate Johnson, MD

  • General Practice Physician
  • Tuscaloosa, AL
  • NPI 1467144949
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684800000000",
    "number": "1063104511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 20TH ST NE",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354041502",
            "telephone_number": "205-771-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 JACK WARNER PKWY NE STE G2",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354045715",
            "telephone_number": "205-771-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTORUP LIFE LAB & CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-23",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ELLORY",
        "authorized_official_middle_name": "KATE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "205-771-2261",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mental Health BD of Bibb Pickens and Tuscaloosa Counties (Indian Rivers Mental Health Center)
• Mental Health Board of Bibb Pickens & Tuscaloosa Counties, Inc.
• Mental Health Board of Bibb Pickens and Tuscaloosa Counties (Indian Rivers CMHC)
• Mental Health Connections, Inc
• Charles John Mentel III, M.D.
• Kathryn Mercer, CRNP
• Willis James Meriwether, DMD
• Elizabeth Rose Merkle, FNP-C
• Mathew M Merritt, MD
• Keri Merschman

• General Practice Physician in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• General Practice Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.