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General NPI Number Information
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NPI Number | 1033260880
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE & ORTHOPEDIC SPECIALISTS, P.C.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 880 MONTCLAIR RD SUITE 577
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City | BIRMINGHAM
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State | AL
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Zip | 35213-1972
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Country | US
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Telephone | 205-595-6757
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Fax | 205-595-0472
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Provider Business Mailing Address
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Address Line | 880 MONTCLAIR RD SUITE 577
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City | BIRMINGHAM
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State | AL
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Zip | 35213-1972
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Country | US
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Telephone | 205-595-6757
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Fax | 205-595-0472
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MANDY PHILLIPS
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Credential |
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Telephone | 205-595-6757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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