Healthcare Provider Details

I. General information

NPI: 1205190097
Provider Name (Legal Business Name): SMALL STEPS PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 MEDICAL PARK DR E SUITE 201
BIRMINGHAM AL
35235-3430
US

IV. Provider business mailing address

52 MEDICAL PARK DR E SUITE 201
BIRMINGHAM AL
35235-3430
US

V. Phone/Fax

Practice location:
  • Phone: 205-868-3486
  • Fax:
Mailing address:
  • Phone: 205-868-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25348
License Number StateAL

VIII. Authorized Official

Name: MS. SHAMEZA LA JOY BOYD
Title or Position: PHYSICIAN
Credential: MD
Phone: 205-868-3486