Healthcare Provider Details

I. General information

NPI: 1508871286
Provider Name (Legal Business Name): MAURICE DONNELL WAINWRIGHT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

PO BOX 19752
BIRMINGHAM AL
35219-9752
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8101
  • Fax: 205-558-4812
Mailing address:
  • Phone: 205-266-0500
  • Fax: 205-558-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-00-2225-W
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number99
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD000548
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: