Provider Demographics
NPI:1861224123
Name:GO MEDICAL CORPORATION PC
Entity type:Organization
Organization Name:GO MEDICAL CORPORATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-612-4769
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-0517
Mailing Address - Country:US
Mailing Address - Phone:205-612-4769
Mailing Address - Fax:
Practice Address - Street 1:605A MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5937
Practice Address - Country:US
Practice Address - Phone:256-558-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GO MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty