Healthcare Provider Details

I. General information

NPI: 1790634103
Provider Name (Legal Business Name): CLINICAL UROLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 WALL ST
ALBERTVILLE AL
35951-9300
US

IV. Provider business mailing address

713 GOODYEAR AVE
GADSDEN AL
35903-1156
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-4040
  • Fax: 256-492-4017
Mailing address:
  • Phone: 256-492-4040
  • Fax: 256-492-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KOURTNEY MAYO FORD
Title or Position: PRACTICE CREDENTIALING MANAGER
Credential:
Phone: 256-492-4040