Healthcare Provider Details

I. General information

NPI: 1073551172
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 10TH AVE S STE 406
BIRMINGHAM AL
35205-1250
US

IV. Provider business mailing address

2700 10TH AVE S STE 406
BIRMINGHAM AL
35205-1250
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-0960
  • Fax: 205-933-0962
Mailing address:
  • Phone: 205-933-0960
  • Fax: 205-933-0962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN LANIER COLEMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 205-933-0960