Healthcare Provider Details

I. General information

NPI: 1396431334
Provider Name (Legal Business Name): TREY LYNN KIDD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47344 US HIGHWAY 78
LINCOLN AL
35096-6748
US

IV. Provider business mailing address

3500 BLUE LAKE DR STE 495
VESTAVIA AL
35243-1975
US

V. Phone/Fax

Practice location:
  • Phone: 205-763-7844
  • Fax: 205-763-7235
Mailing address:
  • Phone: 205-763-7848
  • Fax: 205-763-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.50129
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: