Healthcare Provider Details

I. General information

NPI: 1154543809
Provider Name (Legal Business Name): CATHERINE A. SKINNER, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 UNIVERSITY BLVD E
TUSCALOOSA AL
35401-2029
US

IV. Provider business mailing address

PO BOX 1656
NORTHPORT AL
35476-6656
US

V. Phone/Fax

Practice location:
  • Phone: 205-344-3973
  • Fax:
Mailing address:
  • Phone: 205-344-3973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24177
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number24177
License Number StateAL

VIII. Authorized Official

Name: CATHERINE A SKINNER
Title or Position: OWNER
Credential: M.D.
Phone: 205-344-3973