Healthcare Provider Details

I. General information

NPI: 1629161112
Provider Name (Legal Business Name): THE CHILDREN'S HOSPITAL OF ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ELMER J. BISSELL
BIRMINGHAM AL
35243
US

IV. Provider business mailing address

1940 ELMER J BISSELL RD
BIRMINGHAM AL
35243-2941
US

V. Phone/Fax

Practice location:
  • Phone: 205-824-4949
  • Fax: 205-824-4983
Mailing address:
  • Phone: 205-824-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN WALTON
Title or Position: CFO
Credential:
Phone: 205-638-9901