Cullman Primary Care, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CULLMAN PRIMARY CARE, PC

Practice address

1406 Wall St
Cullman, AL 35055-6011

Phone

(256) 736-2856

Fax

(256) 736-2867

NPI assigned

Jun 23, 2010

Last updated

Jun 15, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

CULLMAN PRIMARY CARE, PCAs reported in NPPES

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

Authorized official

Name

Mrs. Connie Blankenship

Title

Credentialing Coordinator

Phone

(256) 739-0801

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Cullman Primary Care

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1851602981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 CLARK ST NE",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350551921",
            "telephone_number": "256-739-0801",
            "fax_number": "256-739-0027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 WALL ST",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350556011",
            "telephone_number": "256-736-2856",
            "fax_number": "256-736-2867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CULLMAN PRIMARY CARE, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CULLMAN PRIMARY CARE, PC",
        "enumeration_date": "2010-06-23",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "BLANKENSHIP",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "256-739-0801",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529928340",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Cullman, AL
• Providers in Cullman, 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 Jun 15, 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.