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General NPI Number Information
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NPI Number | 1780399832
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Entity Type | Organization
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Legal Business Name | CENTRAL ALABAMA VEIN & AESTHETICS LLC
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 1450 JONES DAIRY RD STE 400
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City | JASPER
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State | AL
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Zip | 35501-6109
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Country | US
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Telephone | 205-737-0307
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 SOUTHBRIDGE PKWY STE 650
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City | BIRMINGHAM
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State | AL
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Zip | 35209-1317
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Country | US
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Telephone | 205-737-0307
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHAEL SOLOMON
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Credential | MD
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Telephone | 205-737-0307
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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