MEDICARE: SAND MOUNTAIN INTERNAL MEDICINE AND GERIATRICS

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	261QP2300X	Primary Care Clinic/Center	2322	AL

General Provider Information

NPI Number	:	1861771792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAND MOUNTAIN INTERNAL MEDICINE AND GERIATRICS

Provider Business Mailing Address
First Line	:	1981 CAHABA CV
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-1823
Country	:	US
Telephone Number	:	205-542-2713
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 W VALLEY AVE STE 214
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-3691
Country	:	US
Telephone Number	:	205-732-3743
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	DR. WENDY RENEE WALKER
Credential	:	M.D.
Telephone Number	:	205-542-2713

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	09/26/2023

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