Healthcare Provider Details

I. General information

NPI: 1619621505
Provider Name (Legal Business Name): SKYLARK MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BROWN CIR
ALABASTER AL
35007-3811
US

IV. Provider business mailing address

3841 VILLAGE CENTER DR
HOOVER AL
35226-6275
US

V. Phone/Fax

Practice location:
  • Phone: 205-984-2729
  • Fax:
Mailing address:
  • Phone: 205-276-0030
  • Fax: 205-289-2870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID M HARDIN
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 205-276-0030