Healthcare Provider Details

I. General information

NPI: 1770872350
Provider Name (Legal Business Name): ANNA CHESSON EDENS HURST MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA CHESSON EDENS MD, MS

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 20TH ST S
BIRMINGHAM AL
35294-0024
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-9567
  • Fax:
Mailing address:
  • Phone: 205-731-9701
  • Fax: 205-297-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number33379
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33379
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: