Healthcare Provider Details

I. General information

NPI: 1699404111
Provider Name (Legal Business Name): CARLY MASHBURN WILLIAMS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PILOT MEDICAL DR STE 300
BIRMINGHAM AL
35235-3412
US

IV. Provider business mailing address

100 PILOT MEDICAL DR STE 300
BIRMINGHAM AL
35235-3412
US

V. Phone/Fax

Practice location:
  • Phone: 205-866-2284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-157931
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: