Healthcare Provider Details

I. General information

NPI: 1083250583
Provider Name (Legal Business Name): TINSLEY PHILLIPS CHAVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DRIVE MASTIN 102
MOBILE AL
36617-2300
US

IV. Provider business mailing address

PO BOX 40480
MOBILE AL
36640-0480
US

V. Phone/Fax

Practice location:
  • Phone: 251-470-5890
  • Fax: 251-471-7925
Mailing address:
  • Phone: 251-434-3626
  • Fax: 251-445-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2760
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: