Healthcare Provider Details

I. General information

NPI: 1679575518
Provider Name (Legal Business Name): CARLA M. SCHAAPHOK PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLA SCHAAPHOK JOHNSON PAC

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 GRANDVIEW PKWY STE 100
BIRMINGHAM AL
35243-3326
US

IV. Provider business mailing address

3670 GRANDVIEW PKWY STE 100
BIRMINGHAM AL
35243-3326
US

V. Phone/Fax

Practice location:
  • Phone: 205-971-1800
  • Fax: 205-971-1801
Mailing address:
  • Phone: 205-971-1800
  • Fax: 205-971-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-161
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: