Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mentorup Life Lab & Clinic

Organization General Practice Physician · NPI 1063104511

Mentorup Life Lab & Clinic is a General Practice Physician in Tuscaloosa, Alabama. Registered with an NPI since 2023.

In the registry since
2023

Practice location Address checks out

535 Jack Warner Pkwy NE Ste G2
Tuscaloosa, AL 35404-5715
Phone: (205) 771-2261
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X

Record details

NPI number1063104511
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ellory Johnson — Medical Director · (205) 771-2261
NPI enumeratedMay 23, 2023
Last updated in NPPESMay 23, 2023
Certification dateMay 23, 2023
Mailing address4202 20th St Ne, Tuscaloosa, AL 35404-1502

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