Healthcare Provider Details

I. General information

NPI: 1033128897
Provider Name (Legal Business Name): ALABAMA DERMATOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3519 WATERMELON RD
NORTHPORT AL
35473-5174
US

IV. Provider business mailing address

3519 WATERMELON RD
NORTHPORT AL
35473-5174
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-1520
  • Fax: 205-345-1761
Mailing address:
  • Phone: 205-345-1520
  • Fax: 205-345-1761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: BRENDA K JONES
Title or Position: OFFICE MANAGER
Credential:
Phone: 205-345-1520