Healthcare Provider Details

I. General information

NPI: 1164479218
Provider Name (Legal Business Name): WENDY W. CORNELIUS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2871 ACTON ROAD SUITE 100
BIRMINGHAM AL
35243-2560
US

IV. Provider business mailing address

2871 ACTON ROAD SUITE 100
BIRMINGHAM AL
35243-2560
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-0023
  • Fax: 205-939-4180
Mailing address:
  • Phone: 205-939-0023
  • Fax: 205-939-4180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA-325
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: