Healthcare Provider Details

I. General information

NPI: 1306310909
Provider Name (Legal Business Name): INJURY SPECIALISTS OF BIRMINGHAM, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 FORD PKWY STE 112A
BESSEMER AL
35022-5283
US

IV. Provider business mailing address

5031 FORD PKWY STE 112A
BESSEMER AL
35022-5283
US

V. Phone/Fax

Practice location:
  • Phone: 205-425-5428
  • Fax: 205-425-7590
Mailing address:
  • Phone: 205-425-5428
  • Fax: 205-425-7590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID GRAHAM
Title or Position: OWNER
Credential: ARNP-C
Phone: 205-425-5428