Healthcare Provider Details

I. General information

NPI: 1245546993
Provider Name (Legal Business Name): PEDIATRIC NEPHROLOGY OF ALABAMA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 RICHARD ARRINGTON JR BLVD S SUITE 206
BIRMINGHAM AL
35205-3898
US

IV. Provider business mailing address

1425 RICHARD ARRINGTON JR BLVD S SUITE 206
BIRMINGHAM AL
35205-3898
US

V. Phone/Fax

Practice location:
  • Phone: 205-558-3200
  • Fax: 205-558-2055
Mailing address:
  • Phone: 205-558-3200
  • Fax: 205-558-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number12284
License Number StateAL

VIII. Authorized Official

Name: MAX MILLER
Title or Position: BILLING MANAGER
Credential:
Phone: 256-562-0025