Healthcare Provider Details

I. General information

NPI: 1932769809
Provider Name (Legal Business Name): ENT ASSOCIATES OF ALABAMA P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 ST. VINCENT'S DRIVE SUITE 402
BIRMINGHAM AL
35205
US

IV. Provider business mailing address

833 ST. VINCENT'S DRIVE SUITE 402
BIRMINGHAM AL
35205
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-9236
  • Fax: 205-933-9213
Mailing address:
  • Phone: 205-933-9236
  • Fax: 205-933-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: KELSEY KOURMOULIS
Title or Position: AUDIOLOGIST
Credential: AU.D.
Phone: 205-212-3574