Healthcare Provider Details

I. General information

NPI: 1174788970
Provider Name (Legal Business Name): AUDRA WOODRUFF EASON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUDRA KINCHEN WOODRUFF

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 MONTCLAIR RD SUITE 955
BIRMINGHAM AL
35213-1923
US

IV. Provider business mailing address

860 MONTCLAIR RD SUITE 955
BIRMINGHAM AL
35213-1923
US

V. Phone/Fax

Practice location:
  • Phone: 205-332-3160
  • Fax: 866-702-0880
Mailing address:
  • Phone: 205-332-3160
  • Fax: 866-702-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number32442
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number32442
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: