Provider Demographics
NPI:1487123915
Name:PHYSICIANS CARE OF CAMDEN LLC
Entity type:Organization
Organization Name:PHYSICIANS CARE OF CAMDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:
Authorized Official - First Name:HUEY
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:334-882-1919
Mailing Address - Street 1:1145 TREVOR CIR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-3546
Mailing Address - Country:US
Mailing Address - Phone:334-534-3826
Mailing Address - Fax:
Practice Address - Street 1:24B CAMDEN BYP
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AL
Practice Address - Zip Code:36726-1770
Practice Address - Country:US
Practice Address - Phone:334-882-1919
Practice Address - Fax:334-636-1989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health