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General NPI Number Information
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NPI Number | 1063576858
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF ALABAMA AT BIRMINGHAM
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 930 20TH ST S SUITE 325
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City | BIRMINGHAM
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State | AL
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Zip | 35205-2610
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Country | US
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Telephone | 205-934-9700
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Fax | 205-975-6962
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Provider Business Mailing Address
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Address Line | 930 20TH ST S SUITE 325
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City | BIRMINGHAM
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State | AL
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Zip | 35205-2610
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Country | US
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Telephone | 205-934-9700
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Fax | 205-975-6962
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TYRA JOHNSON-PIRTLE
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Credential | C.P.A
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Telephone | 205-934-1598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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