Healthcare Provider Details

I. General information

NPI: 1336167196
Provider Name (Legal Business Name): JEFFERSON COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 6TH AVE S
BIRMINGHAM AL
35233-1502
US

IV. Provider business mailing address

PO BOX 2648
BIRMINGHAM AL
35202-2648
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-9110
  • Fax: 205-930-1156
Mailing address:
  • Phone: 205-933-9110
  • Fax: 205-930-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: SHEWANDA CLARK
Title or Position: REVENUE INTEGRITY SUPERVISOR
Credential:
Phone: 205-558-2158