Healthcare Provider Details

I. General information

NPI: 1487760534
Provider Name (Legal Business Name): JASON L ROLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 PRINCETON AVE SW STE 115
BIRMINGHAM AL
35211
US

IV. Provider business mailing address

817 PRINCETON AVE SW STE 115
BIRMINGHAM AL
35211
US

V. Phone/Fax

Practice location:
  • Phone: 205-780-1963
  • Fax: 205-780-2345
Mailing address:
  • Phone: 205-780-1963
  • Fax: 205-780-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25072
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25072
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: