Healthcare Provider Details

I. General information

NPI: 1356911564
Provider Name (Legal Business Name): DRUID CITY PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 UNIVERSITY BLVD E STE 807
TUSCALOOSA AL
35401-7479
US

IV. Provider business mailing address

3901 GREENSBORO AVE STE A
TUSCALOOSA AL
35405-3771
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-6873
  • Fax:
Mailing address:
  • Phone: 205-333-4661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL CLAY CONVILLE
Title or Position: CORP DIRECTOR, PHYSICIAN SERVICES
Credential:
Phone: 205-759-6165