Healthcare Provider Details

I. General information

NPI: 1124328745
Provider Name (Legal Business Name): BIRMINGHAM ADDICTION MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BROOKWOOD MEDICAL CTR DR
BIRMINGHAM AL
35209-6804
US

IV. Provider business mailing address

PO BOX 1118
TRUSSVILLE AL
35173-6100
US

V. Phone/Fax

Practice location:
  • Phone: 205-535-3140
  • Fax: 205-535-3141
Mailing address:
  • Phone: 205-535-3140
  • Fax: 205-535-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number27029
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27029
License Number StateAL

VIII. Authorized Official

Name: DR. TIMOTHY A GOODEN
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 205-535-3140