Healthcare Provider Details

I. General information

NPI: 1245216043
Provider Name (Legal Business Name): SOUTHERN PSYCHIATRIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTURY PARK S SUITE 206
BIRMINGHAM AL
35226-3949
US

IV. Provider business mailing address

100 CENTURY PARK SOUTH SUITE 206
BIRMINGHAM AL
35226-3922
US

V. Phone/Fax

Practice location:
  • Phone: 205-978-7800
  • Fax: 205-978-7802
Mailing address:
  • Phone: 205-978-7800
  • Fax: 205-978-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PEGGY HOLLY
Title or Position: MANAGER
Credential:
Phone: 205-978-7800