Healthcare Provider Details

I. General information

NPI: 1619987302
Provider Name (Legal Business Name): UAHSF NEONATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 NHB 619 SO 19TH ST
BIRMINGHAM AL
35249-0001
US

IV. Provider business mailing address

PO BOX 55823
BIRMINGHAM AL
35255-5823
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-2244
  • Fax: 205-996-2254
Mailing address:
  • Phone: 205-996-2244
  • Fax: 205-996-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAN GENTRY
Title or Position: DIRECTOR PROFESSIONAL SERVICES
Credential:
Phone: 205-975-8850