Ivy Creek of Elmore, LLC

NPI #1093838880 in Wetumpka, Alabama

Provider Information

NPI Number
1093838880
Entity Type
Organization
Organization Name
Ivy Creek of Elmore, LLC
Primary Specialty
Preferred Provider Organization
Enumeration Date
Apr 9, 2007
Last Updated
Aug 22, 2020

Practice Location

Address
74186 TALLASSEE HWY
State
Alabama
ZIP Code
36092-5643
Phone
(334) 567-0346

Authorized Official

Name
GORDON FAULK
Title
CEO
Phone
(334) 567-4311

Specialties & Taxonomy Codes

Specialty
Preferred Provider Organization

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