Healthcare Provider Details

I. General information

NPI: 1497722391
Provider Name (Legal Business Name): KIMBRELL L COLBURN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 SAINT VINCENTS DR SUITE 100
BIRMINGHAM AL
35205-1636
US

IV. Provider business mailing address

805 SAINT VINCENTS DR SUITE 100
BIRMINGHAM AL
35205-1636
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-3699
  • Fax: 205-939-0989
Mailing address:
  • Phone: 205-939-3000
  • Fax: 205-930-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA7
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: