Healthcare Provider Details

I. General information

NPI: 1336198340
Provider Name (Legal Business Name): KEITH R ABRAMS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 LAKESHORE DRIVE SUITE 150
BIRMINGHAM AL
36209
US

IV. Provider business mailing address

2200 LAKESHORE DRIVE SUITE 150
BIRMINGHAM AL
36209
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-6926
  • Fax: 205-871-7981
Mailing address:
  • Phone: 205-871-6926
  • Fax: 205-871-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1048
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: