Healthcare Provider Details

I. General information

NPI: 1619760162
Provider Name (Legal Business Name): DRUID CITY PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 UNIVERSITY BLVD E STE 400
TUSCALOOSA AL
35401-7428
US

IV. Provider business mailing address

701 UNIVERSITY BLVD E STE 400
TUSCALOOSA AL
35401-7428
US

V. Phone/Fax

Practice location:
  • Phone: 205-752-0694
  • Fax: 205-752-6244
Mailing address:
  • Phone: 205-752-0694
  • Fax: 205-752-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL CLAY CONVILLE
Title or Position: VICE PRESIDENT, PHYSICIAN SERVICES
Credential:
Phone: 205-759-6165