Healthcare Provider Details

I. General information

NPI: 1780399832
Provider Name (Legal Business Name): CENTRAL ALABAMA VEIN & AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 JONES DAIRY RD STE 400
JASPER AL
35501-6109
US

IV. Provider business mailing address

2100 SOUTHBRIDGE PKWY STE 650
BIRMINGHAM AL
35209-1317
US

V. Phone/Fax

Practice location:
  • Phone: 205-737-0307
  • Fax:
Mailing address:
  • Phone: 205-737-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL SOLOMON
Title or Position: DIRECTOR
Credential: MD
Phone: 205-737-0307