Healthcare Provider Details

I. General information

NPI: 1144655309
Provider Name (Legal Business Name): BROOKWOOD SPORTS AND ORTHOPEDICS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13521 OLD HIGHWAY 280 STE. 201B
BIRMINGHAM AL
35242-1405
US

IV. Provider business mailing address

PO BOX 742727
ATLANTA GA
30374-2727
US

V. Phone/Fax

Practice location:
  • Phone: 205-877-2663
  • Fax: 205-874-9622
Mailing address:
  • Phone: 205-877-2663
  • Fax: 205-874-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY O. JAMES
Title or Position: REGIONAL CFO, TENET
Credential:
Phone: 404-265-5009