Shalom Family Practice and Medical Spa LLC.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SHALOM FAMILY PRACTICE AND MEDICAL SPA LLC.

Practice address

333 Whitesport Dr SW Ste 304
Huntsville, AL 35801-3455

Phone

(256) 469-0350

Fax

(256) 291-3611

NPI assigned

Feb 23, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Ibukunoluwa Pickens, D.O.

Title

Owner/D.O.

Phone

(256) 469-0350

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1677110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1154020667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 WHITESPORT DR SW STE 304",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358013455",
            "telephone_number": "256-469-0350",
            "fax_number": "256-291-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 WHITESPORT DR SW STE 304",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358013455",
            "telephone_number": "256-469-0350",
            "fax_number": "256-291-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM FAMILY PRACTICE AND MEDICAL SPA LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-23",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "PICKENS",
        "authorized_official_first_name": "IBUKUNOLUWA",
        "authorized_official_title_or_position": "OWNER/D.O.",
        "authorized_official_telephone_number": "256-469-0350",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Huntsville, AL
• Providers in Huntsville, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.