MEDICARE: MS. SELINA GREATHOUSE WOOLVERTON P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA269	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00393710	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51527773	OTHER	AL	ALABAMA BLUE CROSS

General Provider Information

NPI Number	:	1528006970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SELINA GREATHOUSE WOOLVERTON P.A.

Provider Business Mailing Address
First Line	:	1325 MCFARLAND BLVD
Second Line	:	SUITE 102
City	:	NORTHPORT
State	:	AL
Zip	:	35476-3270
Country	:	US
Telephone Number	:	205-333-8800
Fax Number	:	205-333-8406

Provider Business Practice Location Address
First Line	:	1325 MCFARLAND BLVD
Second Line	:	SUITE 102
City	:	NORTHPORT
State	:	AL
Zip	:	35476-3270
Country	:	US
Telephone Number	:	205-333-8800
Fax Number	:	205-333-8406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/17/2008

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Directions to “ MS. SELINA GREATHOUSE WOOLVERTON P.A.” Practice Location

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