Healthcare Provider Details

I. General information

NPI: 1417988452
Provider Name (Legal Business Name): WILLIE JOSEPH CORNAY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 BROOKWOOD BLVD STE 100
BIRMINGHAM AL
35209-7054
US

IV. Provider business mailing address

516 BROOKWOOD BLVD STE 100
BIRMINGHAM AL
35209-7054
US

V. Phone/Fax

Practice location:
  • Phone: 205-776-3131
  • Fax: 205-776-3132
Mailing address:
  • Phone: 205-776-3131
  • Fax: 205-776-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number11181
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: