Healthcare Provider Details

I. General information

NPI: 1427119700
Provider Name (Legal Business Name): ANTHONY A CHESTANG JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 PRINCETON AVE SW
BIRMINGHAM AL
35211-1310
US

IV. Provider business mailing address

PO BOX 12366
BIRMINGHAM AL
35202-2366
US

V. Phone/Fax

Practice location:
  • Phone: 205-206-8461
  • Fax: 205-206-8484
Mailing address:
  • Phone: 205-780-7101
  • Fax: 205-206-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number21119
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: