Healthcare Provider Details

I. General information

NPI: 1003901240
Provider Name (Legal Business Name): ALABAMA PEDIATRIC GASTROENTEROLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 HIGHLAND AVE S SUITE 225
BIRMINGHAM AL
35205-4079
US

IV. Provider business mailing address

2151 HIGHLAND AVE S SUITE 225
BIRMINGHAM AL
35205-4079
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-5744
  • Fax: 205-933-6666
Mailing address:
  • Phone: 205-933-5744
  • Fax: 205-933-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: CARY CAVENDAR
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 205-933-5744