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General NPI Number Information
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NPI Number | 1346330669
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Entity Type | Individual
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Provider Name | ELIZABETH D ENNIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/15/2006
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 840 MONTCLAIR RD SUITE 317
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City | BIRMINGHAM
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State | AL
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Zip | 35213-1920
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Country | US
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Telephone | 205-592-5135
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Fax | 205-592-5694
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Provider Business Mailing Address
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Address Line | 3686 GRANDVIEW PKWY STE 810
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City | BIRMINGHAM
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State | AL
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Zip | 35243-3408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 15220
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License Number State | AL
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