Healthcare Provider Details

I. General information

NPI: 1154983443
Provider Name (Legal Business Name): AIDS ALABAMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 7TH AVE S
BIRMINGHAM AL
35222-3211
US

IV. Provider business mailing address

3521 7TH AVE S
BIRMINGHAM AL
35222-3210
US

V. Phone/Fax

Practice location:
  • Phone: 205-324-9822
  • Fax: 205-324-9881
Mailing address:
  • Phone: 205-324-9822
  • Fax: 205-324-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE HAWTHORNE
Title or Position: CREDENTIALING COORDINATOR
Credential: MS
Phone: 205-310-8051