Healthcare Provider Details

I. General information

NPI: 1871114637
Provider Name (Legal Business Name): JUSTINE ELISE MCGIBONEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUSTINE ELISE MILLER M.D.

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 6TH AVE S # 44A
BIRMINGHAM AL
35233-1801
US

IV. Provider business mailing address

1720 2ND AVENUE SOUTH SRC-044A
BIRMINGHAM AL
35249-7330
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-0826
  • Fax:
Mailing address:
  • Phone: 205-975-0826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.45956
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberMD.45956
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: