Healthcare Provider Details

I. General information

NPI: 1215093224
Provider Name (Legal Business Name): ALABAMA PEDIATRIC PULMONARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 10TH AVENUE SOUTH STE 701
BIRMINGHAM AL
35205-1628
US

IV. Provider business mailing address

2660 10TH AVENUE SOUTH STE 701
BIRMINGHAM AL
35205-1628
US

V. Phone/Fax

Practice location:
  • Phone: 205-776-8789
  • Fax: 205-776-8792
Mailing address:
  • Phone: 205-776-8789
  • Fax: 205-776-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number4130
License Number StateAL

VIII. Authorized Official

Name: DANA MARIE BRASFIELD
Title or Position: SOLE OWNER
Credential: MD
Phone: 205-776-8789