Healthcare Provider Details

I. General information

NPI: 1528341906
Provider Name (Legal Business Name): BROOKWOOD OCCUPATIONAL HEALTH CLINIC, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 EASTERN VALLEY RD SUITE 102
MC CALLA AL
35111-3456
US

IV. Provider business mailing address

4902 VALLEYDALE RD
BIRMINGHAM AL
35242-4613
US

V. Phone/Fax

Practice location:
  • Phone: 205-969-8818
  • Fax: 205-972-8375
Mailing address:
  • Phone: 205-980-8099
  • Fax: 205-980-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY O. JAMES
Title or Position: REGIONAL CFO, TENET
Credential:
Phone: 404-265-5009