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NPI Code Detail

MEDICARE: MS. TERRELL SMITH DORMAN MSW, ACSW

MEDICARE:  MS. TERRELL SMITH DORMAN  MSW, ACSW
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
11041C0700XClinical Social Worker0128CAL

General Provider Information

NPI Number : 1972689032
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TERRELL SMITH DORMAN MSW, ACSW
Provider Business Mailing Address
First Line : 805 INVERNESS LANE
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-3807
Country : US
Telephone Number : 205-991-0045
Fax Number :
Provider Business Practice Location Address
First Line : 1701 AVENUE D
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35218-1532
Country : US
Telephone Number : 205-788-7770
Fax Number : 205-788-7552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/08/2007

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