SOUTHERN GRACE MEDICAL CARE, LLC (NPI# 1649890211) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1649890211 |
Entity Type | Organization |
Organization Name | SOUTHERN GRACE MEDICAL CARE, LLC |
Practice Address |
500 Governors Dr Sw Huntsville AL 35801-5126 |
Mailing Address |
1606 Moontown Rd Brownsboro AL 35741-9493 |
Practice Telephone | 2567974118 |
Mailing Telephone | 2567763850 |
Enumeration Date | 2020-04-23 |
Last Update Date | 2020-04-23 |
Authorized Official Name | JIMMY GREGORY WINN (FAMILY NURSE PRACTITIONER / OWNER) |
Authorized Official Telephone | 2567974118 |
Authorized Official Credential | CRNP, NP-C |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
AL | ALABAMA BOARD OF MEDICAL EXAMINERS | 23529 | 01 |
AL | ALABAMA BOARD OF NURSING, RX NUMBER | 8499 | 01 |
AL | ALABAMA BOARD OF NURSING, RN LICENSE NUMBER | 1-159682 | 01 |
Street Address |
500 GOVERNORS DR SW |
City | HUNTSVILLE |
State | AL |
Zip Code | 35801-5126 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013931757 | Bonnie J Robertson | Nurse Practitioner | 500 Governors Dr Sw, Huntsville, AL 35801-5126 | 2006-07-26 |
1124648258 | Jimmy Gregory Winn | Nurse Practitioner | 500 Governors Dr Sw, Huntsville, AL 35801-5126 | 2020-04-18 |
1710541669 | Trinity Medical Center LLC | Nurse Practitioner | 500 Governors Dr Sw, Huntsville, AL 35801-5126 | 2019-04-25 |
1386935799 | Kim D Lowery | Registered Nurse | 500 Governors Dr Sw, Huntsville, AL 35801-5126 | 2011-04-20 |
1699065888 | The Pinnacle Schools | Residential Treatment Facility, Emotionally Disturbed Children | 500 Governors Dr Sw, Huntsville, AL 35801-5126 | 2011-04-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1003422742 | Elena Mihaela Kruse | Nurse Practitioner | 415 Echurch St, Nw Suite 4, Huntsville, AL 35801 | 2020-09-18 |
1225657661 | Ashley Danielle Ford | Student in an Organized Health Care Education/Training Program | 301 Governors Drive Se, Huntsville, AL 35801 | 2020-04-15 |
1407417702 | Sasha J White | Specialist | 410 Governors Dr. Sw, Huntsville, AL 35801 | 2019-06-26 |
1003472978 | Gina Marie Delgado | Nurse Practitioner | Huntsville Hospital Cvicu, 101 Sivley Rd., Huntsville, AL 35801 | 2019-05-15 |
1366909863 | Lisa Starkey Suggs | Nurse Practitioner | 3500 Memorial Parkway S.w., Huntsville, AL 35801 | 2019-02-21 |
1902373277 | Kelly S Fisher LLC | Counselor | 300 Clinton Avenue, Suite 22 A, Huntsville, AL 35801 | 2018-10-25 |
1073097911 | Brittani B Hamrick | Psychologist | 203 Eastside Sq Ste C9, Huntsville, AL 35801 | 2018-09-17 |
1548748312 | Jane O. Orton, Licsw, LLC | Social Worker | 120 Holmes Ave Ne, Huntsville, AL 35801 | 2018-08-02 |
1184100661 | Regroup Psychological Services | Psychologist | 2006 Franklin St. Se, Suite 110, Huntsville, AL 35801 | 2018-07-17 |
1366968398 | Bennett Brent Smith | Physician Assistant | 825 Adams St. Se, Huntsville, AL 35801 | 2017-08-22 |
Find all providers in zip 35801 |
Taxonomy Code | 261QP2300X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Primary Care |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1194958124 | Center for Adult Medicine & Hypertension, PC | Clinic/Center | 411 Engle Dr Sw, Huntsville, AL 35801-5119 | 2009-08-25 |
1811185424 | Raynon A. Andrews, Md, PC | Clinic/Center | 1878 Jeff Road, Suite A, Huntsville, AL 35806 | 2007-10-09 |
1124216932 | Premier Family Medicine, PC | Clinic/Center | 4820 University Dr Nw Ste 35, Huntsville, AL 35816-1824 | 2007-10-05 |
1255387247 | Regional Spine & Wrist Centers,llc | Clinic/Center | 7540 Memorial Pkwy Sw, Suite W, Huntsville, AL 35802-2265 | 2006-05-25 |
1457962508 | Daniel R Englert Md LLC | Clinic/Center | 101 Bob Wallace Ave Sw Ste D, Huntsville, AL 35801-3843 | 2020-08-12 |
1063066793 | Welbii, LLC | Clinic/Center | 700 Airport Rd Sw Ste D, Huntsville, AL 35802-4360 | 2019-07-31 |
1922667476 | Premium Family Care LLC | Clinic/Center | 333 Whitesport Dr Sw Ste 204, Huntsville, AL 35801-3455 | 2019-06-09 |
1932652989 | Happi Inc | Clinic/Center | 4040 Memorial Pkwy Sw, Suite K, Huntsville, AL 35802-4364 | 2016-07-26 |
1538530860 | Zaheer A. Khan Mdpc | Clinic/Center | 3007 Memorial Pkwy Sw Ste B, Huntsville, AL 35801-5394 | 2015-10-13 |
1487922050 | Fox Army Health Clinic | Clinic/Center | 4100 Goss Rd Sw, Huntsville, AL 35809-0001 | 2011-12-09 |
Find all providers in HUNTSVILLE |
City | HUNTSVILLE |
Zip Code | 35801 |
Please comment or provide details below to improve the information on SOUTHERN GRACE MEDICAL CARE, LLC.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.