Healthcare Provider Details

I. General information

NPI: 1407598840
Provider Name (Legal Business Name): JESSICA LYNN GRADY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MILNER

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 11TH AVE S
BIRMINGHAM AL
35205-3410
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number48162
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48162
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: