Healthcare Provider Details

I. General information

NPI: 1396750121
Provider Name (Legal Business Name): JULIA DANNELLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MONTLIMAR DR
MOBILE AL
36609-1705
US

IV. Provider business mailing address

2147 RIVERCHASE OFFICE RD
BIRMINGHAM AL
35244-1836
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-5263
  • Fax: 251-344-5348
Mailing address:
  • Phone: 205-403-8902
  • Fax: 205-982-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17415
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: