Healthcare Provider Details

I. General information

NPI: 1710037619
Provider Name (Legal Business Name): MILLIE M MCDANIEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 7TH AVE S STE 100
BIRMINGHAM AL
35233-3215
US

IV. Provider business mailing address

2316 7TH AVE S STE 100
BIRMINGHAM AL
35233-3215
US

V. Phone/Fax

Practice location:
  • Phone: 205-326-6993
  • Fax: 205-251-2004
Mailing address:
  • Phone: 205-326-6993
  • Fax: 205-251-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAL4066
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: