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General NPI Number Information
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NPI Number | 1720393606
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Entity Type | Organization
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Legal Business Name | MIBELLA GYNECOLOGY, LLC
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 2807 GREYSTONE COMMERCIAL BLVD UNIT 38
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City | BIRMINGHAM
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State | AL
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Zip | 35242-9601
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Country | US
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Telephone | 205-995-1009
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Fax | 205-995-1049
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Provider Business Mailing Address
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Address Line | 2807 GREYSTONE COMMERCIAL BLVD UNIT 38
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City | BIRMINGHAM
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State | AL
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Zip | 35242-9601
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Country | US
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Telephone | 205-995-1009
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Fax | 205-995-1049
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIA T COWAN
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Credential | M.D.
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Telephone | 205-995-1009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 27416
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License Number State | AL
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