Healthcare Provider Details

I. General information

NPI: 1477556991
Provider Name (Legal Business Name): VIRGINIA RUTH LOLLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 UNIVERSITY BLVD STE 200
BIRMINGHAM AL
35233-1816
US

IV. Provider business mailing address

PO BOX 59449
BIRMINGHAM AL
35259-9449
US

V. Phone/Fax

Practice location:
  • Phone: 205-876-8988
  • Fax: 205-390-6460
Mailing address:
  • Phone: 205-876-8988
  • Fax: 205-390-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number19079
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: