Healthcare Provider Details

I. General information

NPI: 1114025103
Provider Name (Legal Business Name): THE CHILDREN'S HOSPITAL OF ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S IRELAND CENTER-4TH FLOOR DEARTH
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

PO BOX 114070536
BIRMINGHAM AL
35246-0536
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-9193
  • Fax: 205-638-9949
Mailing address:
  • Phone: 205-638-5600
  • Fax: 205-638-5623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DAWN WALTON
Title or Position: CFO
Credential:
Phone: 205-638-9901