Healthcare Provider Details

I. General information

NPI: 1205264686
Provider Name (Legal Business Name): HORMONE HEALTH AND WEIGHT LOSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CENTURY PARK S SUITE 112
BIRMINGHAM AL
35226-3943
US

IV. Provider business mailing address

700 CENTURY PARK S SUITE 112
BIRMINGHAM AL
35226-3943
US

V. Phone/Fax

Practice location:
  • Phone: 205-822-3211
  • Fax: 205-822-3321
Mailing address:
  • Phone: 205-822-3211
  • Fax: 205-822-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateAL

VIII. Authorized Official

Name: AMANDA BLACKALL
Title or Position: OFFICE COORDINATOR
Credential:
Phone: 205-822-3211