Coosa Valley Sports Medicine and Primary Care LLC

NPI #1871924357 in Sylacauga, Alabama

Provider Information

NPI Number: 1871924357
Entity Type: Organization
Organization Name: Coosa Valley Sports Medicine and Primary Care LLC
Primary Specialty: Internal Medicine
Enumeration Date: Dec 9, 2013
Last Updated: Dec 9, 2013

Practice Location

Address: 209 W SPRING ST
Address 2: SUITE 305
City: Sylacauga
State: Alabama
ZIP Code: 35150-2973
Phone: (256) 245-3201

Authorized Official

Name: KENNIETH C MCCOLLOUGH, M.D.
Title: OWNER
Phone: (256) 245-3201

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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