is a Specialist in Birmingham, Alabama. practices all healthcare services and medical treatments related to Specialist. The NPI Number for is 1770740482. The last update date is .
's current location address is 3125 Independence Dr, Birmingham, Alabama. You can contact this provider via phone number 2058798206 and fax number 2058790675. The mailing address for is 3125 Independence Dr, Birmingham, Alabama. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 3125 Independence Dr, Birmingham, Alabama |
| Phone Number | 2058798206 |
| Fax Number | 2058790675 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1770740482 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 3125 Independence Dr |
|---|---|
| City | Birmingham |
| State | Alabama (AL) |
| Post Code | 352094159 |
| Phone Number | 2058798206 |
| Fax Number | 2058790675 |
Provider's Primary Taxonomy Detail
| Speciality | Specialist |
|---|---|
| Taxonomy | 174400000X |
| Licence No | 14105 |
|
Definition: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| I621 | AL | MEDICARE GROUP IDENTIFIER |
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