Healthcare Provider Details

I. General information

NPI: 1093025215
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALISTS OF ALABAMA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 1ST ST. NORTH STE. 220
ALABASTER AL
35007-8706
US

IV. Provider business mailing address

4295 CROMWELL RD. STE. 308
CHATTANOOGA TN
37421-2163
US

V. Phone/Fax

Practice location:
  • Phone: 205-621-3778
  • Fax: 205-621-4835
Mailing address:
  • Phone: 423-702-7536
  • Fax: 423-877-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER FREED
Title or Position: CREDENTIALING
Credential:
Phone: 423-702-7536