=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972525004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIOVASCULAR ASSOCIATES OF NORTH ALABAMA, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1528 CARRAWAY BLVD 3RD FLOOR
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35234-1998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-250-6964
-----------------------------------------------------
Fax | 205-250-8916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1280 COLUMBIANA RD SUITE 100
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35216-1642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-599-3525
-----------------------------------------------------
Fax | 205-599-3569
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL STAFF AFFAIRS COORDINATOR
-----------------------------------------------------
Name | PATRICIA HAWK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-599-3524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------