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General NPI Number Information
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NPI Number | 1710299425
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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 | 07/10/2010
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 930 20TH ST S SUITE 101
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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 | 205-934-5471
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Fax | 205-975-2380
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Provider Business Mailing Address
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Address Line | 1530 3RD AVE S CH19 307
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City | BIRMINGHAM
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State | AL
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Zip | 35294-2041
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Country | US
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Telephone | 205-934-5471
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Fax | 205-975-2380
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Authorized Official
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Title or Position | DIRECTOR
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Name | LATAMIA WHITE-GREEN
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Credential | M.D.
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Telephone | 205-934-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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