Healthcare Provider Details

I. General information

NPI: 1992962104
Provider Name (Legal Business Name): ORTHOPEDICS FOR KIDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 10/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 10TH AVE S SUITE 107
BIRMINGHAM AL
35205-1605
US

IV. Provider business mailing address

2660 10TH AVE S SUITE 107
BIRMINGHAM AL
35205-1605
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8588
  • Fax: 205-933-7203
Mailing address:
  • Phone: 205-933-8588
  • Fax: 205-933-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHARON K MAYBERRY
Title or Position: PARTNER
Credential: MD
Phone: 205-933-8588