Healthcare Provider Details

I. General information

NPI: 1386849669
Provider Name (Legal Business Name): BROOKWOOD OPHTHALMOLOGY IMAGING AND ANCILLARY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHASE CORPORATE DR STE 439
HOOVER AL
35244-1026
US

IV. Provider business mailing address

1 CHASE CORPORATE DR STE 439
HOOVER AL
35244-1026
US

V. Phone/Fax

Practice location:
  • Phone: 205-313-6300
  • Fax: 253-465-4859
Mailing address:
  • Phone: 205-313-6300
  • Fax: 253-645-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANIE NORFLEET WHITE
Title or Position: PRESIDENT
Credential:
Phone: 205-383-9498