Healthcare Provider Details

I. General information

NPI: 1376970236
Provider Name (Legal Business Name): SKIN PATHOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 INDEPENDENCE DR
BIRMINGHAM AL
35209-5710
US

IV. Provider business mailing address

3560 INDEPENDENCE DR SUITE 200
BIRMINGHAM AL
35209-5703
US

V. Phone/Fax

Practice location:
  • Phone: 205-949-2806
  • Fax: 205-949-2810
Mailing address:
  • Phone: 205-949-2806
  • Fax: 205-949-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberL37107
License Number StateAL

VIII. Authorized Official

Name: STEPHANIE HIGGINS
Title or Position: CREDENTIALING
Credential:
Phone: 205-949-2834