Healthcare Provider Details

I. General information

NPI: 1528011079
Provider Name (Legal Business Name): KELLI FOLGMAN GRINDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 STOUTS RD
FULTONDALE AL
35068-1962
US

IV. Provider business mailing address

PO BOX 830230
BIRMINGHAM AL
35283-0230
US

V. Phone/Fax

Practice location:
  • Phone: 205-849-9811
  • Fax: 205-849-9812
Mailing address:
  • Phone: 205-250-6006
  • Fax: 205-250-8139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25673
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: