NPI 1063104511

Mentorup Life Lab & Clinic

Organisation General Practice Physician Tuscaloosa, AL

Practice location

Address: 535 Jack Warner Pkwy NE STE G2, Tuscaloosa, AL 35404-5715
Phone: (205) 771-2261
Mailing address: 4202 20th St NE, Tuscaloosa, AL 35404-1502

Authorised official

Name: Ellory Kate Johnson
Title: Medical Director
Phone: (205) 771-2261

Registered specialties

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X

Other General Practice providers in Alabama →

Registry record

NPI: 1063104511
Entity type: Organization
NPI issued: 23 May 2023
Record last updated: 23 May 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.