Healthcare Provider Details

I. General information

NPI: 1295784148
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES OF NORTH ALABAMA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 COLUMBIANA RD SUITE 100
BIRMINGHAM AL
35216-1642
US

IV. Provider business mailing address

1280 COLUMBIANA RD SUITE 100
BIRMINGHAM AL
35216-1642
US

V. Phone/Fax

Practice location:
  • Phone: 205-599-3540
  • Fax: 205-599-6333
Mailing address:
  • Phone: 205-599-3540
  • Fax: 205-599-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DENISE NELSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 423-702-7555