Healthcare Provider Details

I. General information

NPI: 1861782625
Provider Name (Legal Business Name): CALVIN ALPHONSO SPELLMON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 02/01/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 1ST ST N
ALABASTER AL
35007-8944
US

IV. Provider business mailing address

831 1ST ST N
ALABASTER AL
35007-8944
US

V. Phone/Fax

Practice location:
  • Phone: 205-663-8530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35176
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2014-0025
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMD.35176
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD.35176
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: