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NPI Code Detail

MEDICARE: JIMMY L CLEVELAND PA

MEDICARE: JIMMY L CLEVELAND PA
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
1363A00000XPhysician AssistantPA106AL

General Provider Information

NPI Number : 1639137292
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIMMY L CLEVELAND PA
Provider Business Mailing Address
First Line : PO BOX 2324
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35201-2324
Country : US
Telephone Number : 818-340-9988
Fax Number : 818-587-2493
Provider Business Practice Location Address
First Line : 400 TAYLOR RD
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-3512
Country : US
Telephone Number : 818-340-9988
Fax Number : 818-587-2493
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 07/08/2007

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Directions to “ JIMMY L CLEVELAND PA” Practice Location

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