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General NPI Number Information
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NPI Number | 1588688873
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Entity Type | Individual
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Provider Name | JAMES WILLIAM CUSTIS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 3911 10TH AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35222-4207
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Country | US
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Telephone | 205-999-6456
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 130111
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City | BIRMINGHAM
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State | AL
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Zip | 35213-0111
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Country | US
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Telephone | 205-999-6456
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25110
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 25110
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 00025110
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License Number State | AL
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