=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740469311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GONZALEZ & CARR, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2007
-----------------------------------------------------
Last Update Date | 10/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 HEATHERBROOKE PARK DR
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-8008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-991-9787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 HEATHERBROOKE PARK DR
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-8008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-991-9787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | LACY N JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-991-9787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 3935
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 3923
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------