Healthcare Provider Details

I. General information

NPI: 1841301082
Provider Name (Legal Business Name): ENT ASSOCIATES OF ALABAMA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SAINT VINCENTS DR POB#3 SUITE 402
BIRMINGHAM AL
35205-1606
US

IV. Provider business mailing address

833 SAINT VINCENTS DR POB#3 SUITE 402
BIRMINGHAM AL
35205-1606
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-9236
  • Fax: 205-933-9213
Mailing address:
  • Phone: 205-933-9236
  • Fax: 205-933-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANNE P NICHOLS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 205-933-9236