Healthcare Provider Details

I. General information

NPI: 1295916955
Provider Name (Legal Business Name): BHC-PRINCETON MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 PRINCETON AVE SW POB III; SUITE 200B
BIRMINGHAM AL
35211-1323
US

IV. Provider business mailing address

3201 4TH AVE S
BIRMINGHAM AL
35222-1723
US

V. Phone/Fax

Practice location:
  • Phone: 205-781-3752
  • Fax: 205-788-6551
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE SCOTT FENN
Title or Position: PRESIDENT - CHIEF INTEGRATION OFFIC
Credential:
Phone: 205-715-5415