Healthcare Provider Details

I. General information

NPI: 1013916725
Provider Name (Legal Business Name): PHP OF ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 CENTER POINT PKWY
BIRMINGHAM AL
35215-3608
US

IV. Provider business mailing address

2352 CENTER POINT PKWY
BIRMINGHAM AL
35215-3608
US

V. Phone/Fax

Practice location:
  • Phone: 205-854-7272
  • Fax: 205-854-7770
Mailing address:
  • Phone: 205-854-7272
  • Fax: 205-854-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateAL

VIII. Authorized Official

Name: MS. GLORIA SANFORD
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 205-854-7272