Provider Demographics
NPI:1063523421
Name:LINCOLN FAMILY PRACTICE PC
Entity type:Organization
Organization Name:LINCOLN FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PONDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-763-1414
Mailing Address - Street 1:1100 PATTON CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:AL
Mailing Address - Zip Code:35096-4723
Mailing Address - Country:US
Mailing Address - Phone:205-763-1414
Mailing Address - Fax:205-763-1447
Practice Address - Street 1:1100 PATTON CHAPEL RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:AL
Practice Address - Zip Code:35096-4723
Practice Address - Country:US
Practice Address - Phone:205-763-1414
Practice Address - Fax:205-763-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529927600Medicaid