Healthcare Provider Details

I. General information

NPI: 1003868977
Provider Name (Legal Business Name): LEROY SCOTT ATKINS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 PAUL BRYANT DR
TUSCALOOSA AL
35401-2094
US

IV. Provider business mailing address

305 PAUL BRYANT DR
TUSCALOOSA AL
35401-2094
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-0192
  • Fax: 205-247-2194
Mailing address:
  • Phone: 205-345-0192
  • Fax: 205-247-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number15931
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: