Healthcare Provider Details

I. General information

NPI: 1427143825
Provider Name (Legal Business Name): AUDIE LEE WOOLLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ELMER J. BISSELL ROAD
BRIMINGHAM AL
35243
US

IV. Provider business mailing address

2285 TANGLEWOOD BROOK LANE
BIRMINGHAM AL
35243
US

V. Phone/Fax

Practice location:
  • Phone: 205-824-4949
  • Fax: 205-824-4983
Mailing address:
  • Phone: 205-969-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number18970
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: