Healthcare Provider Details

I. General information

NPI: 1760895866
Provider Name (Legal Business Name): KELLY SUE SAYRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 6TH AVE S FL 1
BIRMINGHAM AL
35233-2110
US

IV. Provider business mailing address

1919 7TH AVE S STE 419
BIRMINGHAM AL
35233-2005
US

V. Phone/Fax

Practice location:
  • Phone: 205-801-7703
  • Fax:
Mailing address:
  • Phone: 205-934-4345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD.40423
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: