Healthcare Provider Details

I. General information

NPI: 1760685523
Provider Name (Legal Business Name): AFFINITY HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MONTCLAIR RD
BIRMINGHAM AL
35213-1908
US

IV. Provider business mailing address

PO BOX 403804
ATLANTA GA
30384-3804
US

V. Phone/Fax

Practice location:
  • Phone: 205-592-1891
  • Fax: 205-592-5653
Mailing address:
  • Phone: 205-592-1891
  • Fax: 205-592-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberL3797
License Number StateAL

VIII. Authorized Official

Name: PAULA M LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 615-925-4565