Healthcare Provider Details

I. General information

NPI: 1154031789
Provider Name (Legal Business Name): SIMON WILLIAMSON CLINIC PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 PRINCETON AVE SW STE 100
BIRMINGHAM AL
35211-1320
US

IV. Provider business mailing address

832 PRINCETON AVE SW STE 100
BIRMINGHAM AL
35211-1320
US

V. Phone/Fax

Practice location:
  • Phone: 205-206-8480
  • Fax: 205-206-8448
Mailing address:
  • Phone: 205-206-8480
  • Fax: 205-206-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH SAHLIE
Title or Position: SHAREHOLDER
Credential: MD
Phone: 205-206-8480