Healthcare Provider Details

I. General information

NPI: 1710095104
Provider Name (Legal Business Name): MONTCLAIR RHEUMATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MONTCLAIR RD SUITE 470
BIRMINGHAM AL
35213-1972
US

IV. Provider business mailing address

880 MONTCLAIR RD SUITE 470
BIRMINGHAM AL
35213-1972
US

V. Phone/Fax

Practice location:
  • Phone: 205-591-2758
  • Fax: 205-592-0318
Mailing address:
  • Phone: 205-591-2758
  • Fax: 205-592-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CORNELIUS B THOMAS
Title or Position: PRESIDENT
Credential: MD
Phone: 205-591-2758