Healthcare Provider Details

I. General information

NPI: 1184738478
Provider Name (Legal Business Name): UNIVERSITY OF ALABAMA AT BIRMINGHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E SOUTH BLVD SUITE 202
MONTGOMERY AL
36116-2002
US

IV. Provider business mailing address

2055 E SOUTH BLVD SUITE 202
MONTGOMERY AL
36116-2002
US

V. Phone/Fax

Practice location:
  • Phone: 334-284-5211
  • Fax: 334-284-9020
Mailing address:
  • Phone: 334-284-5211
  • Fax: 334-284-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF DENNEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-229-0178