Healthcare Provider Details

I. General information

NPI: 1992812887
Provider Name (Legal Business Name): HARRY B. WHEELOCK JR. P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MEDICAL PARK DR E SUITE 255
BIRMINGHAM AL
35235-3400
US

IV. Provider business mailing address

48 MEDICAL PARK DR E SUITE 255
BIRMINGHAM AL
35235-3400
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3090
  • Fax: 205-838-6783
Mailing address:
  • Phone: 205-838-3090
  • Fax: 205-838-6783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberPA-57
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: