Healthcare Provider Details

I. General information

NPI: 1760665459
Provider Name (Legal Business Name): GIA S RANDALL WOOLEN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GIA FREEMAN

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 SAINT VINCENTS DR # 720
BIRMINGHAM AL
35205-1601
US

IV. Provider business mailing address

810 ST VINCENTS DR POB 1 SUITE #720
BIRMINGHAM AL
35205
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-2456
  • Fax:
Mailing address:
  • Phone: 205-930-2456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA052202
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006451
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number.821
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: