Healthcare Provider Details

I. General information

NPI: 1174736078
Provider Name (Legal Business Name): NATALIE H. TIBBETTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 PRINCETON AVENUE SW
BIRMINGHAM AL
35211-1323
US

IV. Provider business mailing address

PO BOX 12366
BIRMINGHAM AL
35202-2366
US

V. Phone/Fax

Practice location:
  • Phone: 205-206-8480
  • Fax: 205-206-8365
Mailing address:
  • Phone: 205-780-7101
  • Fax: 205-206-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27156
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: