Healthcare Provider Details

I. General information

NPI: 1477290237
Provider Name (Legal Business Name): AUDREY DENISE GOLDSMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 FORESTDALE BLVD STE 201
BIRMINGHAM AL
35214-3022
US

IV. Provider business mailing address

1329 FORESTDALE BLVD STE 201
BIRMINGHAM AL
35214-3022
US

V. Phone/Fax

Practice location:
  • Phone: 205-470-3300
  • Fax: 205-734-0919
Mailing address:
  • Phone: 205-470-3300
  • Fax: 205-734-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number1-121003
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1-121003
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: