Healthcare Provider Details

I. General information

NPI: 1043261969
Provider Name (Legal Business Name): JOEL ASHBY MIXON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MONTCLAIR ROAD
BIRMINGHAM AL
35213-1908
US

IV. Provider business mailing address

PO BOX 55310 STE 300
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-592-1000
  • Fax:
Mailing address:
  • Phone: 205-731-9701
  • Fax: 205-297-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME170628
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number24931
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: