Healthcare Provider Details

I. General information

NPI: 1184789588
Provider Name (Legal Business Name): BIRMINGHAM EAR, NOSE & THROAT GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 10TH AVE S STE 502
BIRMINGHAM AL
35205-1250
US

IV. Provider business mailing address

2700 10TH AVE S STE 502
BIRMINGHAM AL
35205-1250
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-2952
  • Fax: 205-933-5893
Mailing address:
  • Phone: 205-933-2952
  • Fax: 205-933-5893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number00010997
License Number StateAL

VIII. Authorized Official

Name: MRS. MARCIA L LOWRY
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-933-2952