Healthcare Provider Details

I. General information

NPI: 1730185455
Provider Name (Legal Business Name): CUNNINGHAM PATHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 MONTCLAIR RD STE 200
BIRMINGHAM AL
35213-1200
US

IV. Provider business mailing address

924 MONTCLAIR RD STE 200
BIRMINGHAM AL
35213-1200
US

V. Phone/Fax

Practice location:
  • Phone: 205-591-7999
  • Fax: 205-591-5051
Mailing address:
  • Phone: 205-591-7999
  • Fax: 205-591-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number09827
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number09827
License Number StateAL

VIII. Authorized Official

Name: SHEILA HALL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 205-591-7999