Healthcare Provider Details

I. General information

NPI: 1447236658
Provider Name (Legal Business Name): GERALD KEITH ANDERSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTURY PARK S SUITE 206
BIRMINGHAM AL
35226-3949
US

IV. Provider business mailing address

100 CENTURY PARK S SUITE 206
BIRMINGHAM AL
35226-3949
US

V. Phone/Fax

Practice location:
  • Phone: 205-978-7800
  • Fax:
Mailing address:
  • Phone: 205-978-7800
  • Fax: 205-978-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number290
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: