Healthcare Provider Details

I. General information

NPI: 1730351248
Provider Name (Legal Business Name): PAMELA KELLY PULLEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 14TH AVE S
BIRMINGHAM AL
35205-4969
US

IV. Provider business mailing address

1830 14TH AVE S
BIRMINGHAM AL
35205-4969
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8436
  • Fax: 205-933-2221
Mailing address:
  • Phone: 205-933-8436
  • Fax: 205-933-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number06012756
License Number StateAL

VIII. Authorized Official

Name: MRS. PAMELA KELLY PULLEN
Title or Position: OWNER
Credential: OPTICIAN
Phone: 205-933-8436