Healthcare Provider Details

I. General information

NPI: 1730709544
Provider Name (Legal Business Name): JUSTIN C ROLAND CRNP, AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 02/01/2024
Certification Date: 11/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

3400 BIG PAUL CIR
VESTAVIA HILLS AL
35216-4814
US

V. Phone/Fax

Practice location:
  • Phone: 205-394-2440
  • Fax:
Mailing address:
  • Phone: 256-861-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-154461
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-154461
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: