Healthcare Provider Details

I. General information

NPI: 1871039263
Provider Name (Legal Business Name): MICHAEL A BOZEMAN ALC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 ROCKY RIDGE LN
BIRMINGHAM AL
35216-4809
US

IV. Provider business mailing address

PO BOX 362084
BIRMINGHAM AL
35236-2084
US

V. Phone/Fax

Practice location:
  • Phone: 205-945-0031
  • Fax:
Mailing address:
  • Phone: 205-945-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC2770A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: