Healthcare Provider Details

I. General information

NPI: 1528280609
Provider Name (Legal Business Name): TAJUAN M WOODY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 MONTCLAIR RD
BIRMINGHAM AL
35213-1204
US

IV. Provider business mailing address

972 MONTCLAIR RD
BIRMINGHAM AL
35213-1204
US

V. Phone/Fax

Practice location:
  • Phone: 205-957-5445
  • Fax: 205-957-5501
Mailing address:
  • Phone: 205-957-5445
  • Fax: 205-957-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2053
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: