Provider Demographics
NPI:1326873514
Name:FAIRVIEW FAMILY CLINIC LLC
Entity type:Organization
Organization Name:FAIRVIEW FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KINDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-640-5761
Mailing Address - Street 1:PO BOX 1370
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-1370
Mailing Address - Country:US
Mailing Address - Phone:256-595-8554
Mailing Address - Fax:256-853-0850
Practice Address - Street 1:485 APPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:LACEYS SPRING
Practice Address - State:AL
Practice Address - Zip Code:35754-6551
Practice Address - Country:US
Practice Address - Phone:256-640-5761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty