Southern Grace Medical Care, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTHERN GRACE MEDICAL CARE, LLC

Practice address

500 Governors Dr SW
Huntsville, AL 35801-5126

Phone

(256) 797-4118

NPI assigned

Apr 23, 2020

Last updated

Apr 23, 2020By 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

Jimmy Gregory Winn, CRNP, NP-CNPI 1124648258

Title

Family Nurse Practitioner / Owner

Phone

(256) 797-4118

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Practitioners 3

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.

• Jimmy Gregory Winn, CRNP

  • Primary Care Nurse Practitioner
  • Madison, AL
  • NPI 1124648258
  Medicare reassignment NPD Authorized official
• Perry L Swann, MD

  • Family Medicine Physician
  • Altoona, AL
  • NPI 1871589481
  Medicare reassignment NPD
• Davonia Taylor

  • Primary Care Nurse Practitioner
  • Huntsville, AL
  • NPI 1508483454
  Medicare reassignment NPD

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

{
    "created_epoch": "1587600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587600000000",
    "number": "1649890211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 MOONTOWN RD",
            "city": "BROWNSBORO",
            "state": "AL",
            "postal_code": "357419493",
            "telephone_number": "256-776-3850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 GOVERNORS DR SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358015126",
            "telephone_number": "256-797-4118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN GRACE MEDICAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-23",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A",
        "authorized_official_last_name": "WINN",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER / OWNER",
        "authorized_official_telephone_number": "256-797-4118",
        "authorized_official_credential": "CRNP, NP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALABAMA BOARD OF MEDICAL EXAMINERS",
            "identifier": "23529",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALABAMA BOARD OF NURSING, RX NUMBER",
            "identifier": "8499",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALABAMA BOARD OF NURSING, RN LICENSE NUMBER",
            "identifier": "1-159682",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@southerngracemed.com",
            "affiliation": "N",
            "endpointDescription": "Practice owner's company email address",
            "address_1": "500 Governors Dr SW",
            "city": "Huntsville",
            "state": "AL",
            "country_code": "US",
            "postal_code": "358015126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Laura Kelly South, PHARM.D
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• Southern Comfort for Feet
• Southern Family Markets LLC (Southern Family Market)
• Southern Medical Equipment, Corp
• Randall Keith Southern, EDD, LPC
• Phillip Jason Southers, RBT
• Southside Chiropractic & Acupuncture Center Inc
• John K Sowell, MD

• Primary Care Clinic/Center in Huntsville, AL
• Providers in Huntsville, AL by specialty
• Primary Care Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.