Healthcare Provider Details

I. General information

NPI: 1972858140
Provider Name (Legal Business Name): CHILTON COUNTY ORTHOPAEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 10TH AVE S SUITE 200
BIRMINGHAM AL
35205-1200
US

IV. Provider business mailing address

1010 LAY DAM RD
CLANTON AL
35045-2306
US

V. Phone/Fax

Practice location:
  • Phone: 205-259-3991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number27170
License Number StateAL

VIII. Authorized Official

Name: JAMES VANN WORTHEN
Title or Position: PHYSICIAN
Credential: MD
Phone: 205-259-3991