Healthcare Provider Details

I. General information

NPI: 1164590352
Provider Name (Legal Business Name): BROOKWOOD OB-GYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BROOKWOOD MEDICAL CTR DR SUITE 202, WMP
BIRMINGHAM AL
35209-6899
US

IV. Provider business mailing address

2006 BROOKWOOD MEDICAL CTR DR SUITE 202, WMP
BIRMINGHAM AL
35209-6899
US

V. Phone/Fax

Practice location:
  • Phone: 205-877-2850
  • Fax: 205-877-2858
Mailing address:
  • Phone: 205-877-2850
  • Fax: 205-877-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAL

VIII. Authorized Official

Name: DR. JACK B FREEMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-877-2850