Gmuc of Tillmans Corner

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

GMUC OF TILLMANS CORNER

Practice address

5100 Rangeline Service Rd N
Mobile, AL 36619-9504

Phone

(251) 633-0123

Fax

(251) 445-3722

NPI assigned

Aug 11, 2014

Organization subpart

No

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

Authorized official

Name

Darren Waters, MD

Title

Partner

Phone

(251) 633-0123

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1407715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407715200000",
    "number": "1386053783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 RANGELINE SERVICE RD N",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366199504",
            "telephone_number": "251-633-0123",
            "fax_number": "251-445-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 RANGELINE SERVICE RD N",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366199504",
            "telephone_number": "251-633-0123",
            "fax_number": "251-445-3722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GMUC OF TILLMANS CORNER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-11",
        "last_updated": "2014-08-11",
        "status": "A",
        "authorized_official_last_name": "WATERS",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "251-633-0123",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Mobile, AL
• Providers in Mobile, 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 Aug 11, 2014; 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.