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General NPI Number Information
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NPI Number | 1093896466
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Entity Type | Organization
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Legal Business Name | EASTERN NEPHROLOGY, PC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 1524 HUFFMAN ROAD
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City | BIRMINGHAM
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State | AL
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Zip | 35215
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Country | US
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Telephone | 205-856-0011
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Fax | 205-856-0726
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Provider Business Mailing Address
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Address Line | 1524 HUFFMAN ROAD
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City | BIRMINGHAM
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State | AL
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Zip | 35215
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Country | US
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Telephone | 205-856-0011
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Fax | 205-856-0726
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Authorized Official
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Title or Position | BILLING
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Name | MS. KELLY F AMERSON
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Credential |
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Telephone | 205-856-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 0007283
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 00007283
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License Number State | AL
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