Healthcare Provider Details

I. General information

NPI: 1114338597
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF BIRMINGHAM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RIDGEWAY DR
BIRMINGHAM AL
35209-5506
US

IV. Provider business mailing address

250 LUCERNE BLVD
BIRMINGHAM AL
35209-6614
US

V. Phone/Fax

Practice location:
  • Phone: 205-612-1659
  • Fax:
Mailing address:
  • Phone: 205-612-1659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD16619
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD16619
License Number StateAL

VIII. Authorized Official

Name: JOHN BARRY KING
Title or Position: PRESIDENT AND SECRETARY
Credential: M.D.
Phone: 205-612-1659