Healthcare Provider Details

I. General information

NPI: 1316459746
Provider Name (Legal Business Name): GARDENDALE PAIN AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 DECATUR HWY STE 101
GARDENDALE AL
35071-2384
US

IV. Provider business mailing address

2215 DECATUR HWY STE 101
GARDENDALE AL
35071-2384
US

V. Phone/Fax

Practice location:
  • Phone: 205-608-8199
  • Fax: 205-608-8195
Mailing address:
  • Phone: 205-608-8199
  • Fax: 205-608-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: RICKY B TUBBS
Title or Position: OWNER
Credential: DO
Phone: 256-649-0416