Healthcare Provider Details

I. General information

NPI: 1225348527
Provider Name (Legal Business Name): BROOKWOOD PRIMARY CARE VESTAVIA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 CANYON RD SUITE 39
VESTAVIA AL
35216-1900
US

IV. Provider business mailing address

4902 VALLEYDALE RD
BIRMINGHAM AL
35242-4613
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-7746
  • Fax: 205-871-9234
Mailing address:
  • Phone: 205-980-8099
  • Fax: 205-980-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY O. JAMES
Title or Position: REGIONAL CFO, TENET
Credential:
Phone: 404-265-5009