Healthcare Provider Details

I. General information

NPI: 1740469311
Provider Name (Legal Business Name): GONZALEZ & CARR, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HEATHERBROOKE PARK DR
BIRMINGHAM AL
35242-8008
US

IV. Provider business mailing address

101 HEATHERBROOKE PARK DR
BIRMINGHAM AL
35242-8008
US

V. Phone/Fax

Practice location:
  • Phone: 205-991-9787
  • Fax:
Mailing address:
  • Phone: 205-991-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3935
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3923
License Number StateAL

VIII. Authorized Official

Name: LACY N JOHNSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-991-9787