Healthcare Provider Details

I. General information

NPI: 1689683740
Provider Name (Legal Business Name): MARY KATHLEEN INGRAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 ST VINCENTS DRIVE SUITE 500
BIRMINGHAM AL
35205
US

IV. Provider business mailing address

806 ST VINCENTS DRIVE SUITE 500
BIRMINGHAM AL
35205
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-1800
  • Fax: 205-930-1819
Mailing address:
  • Phone: 205-930-1800
  • Fax: 205-930-1819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25165
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: