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Specialty details in registry · Birmingham, AL

Call (719) 517-6905 Directions

At a glance

2100 Southbridge Pkwy, Birmingham, AL 35209-1317

NPPES record updated Apr 7, 2026. Public records can lag behind changes at a practice.

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  • Are you accepting new patients?
  • Do you accept my specific insurance plan?
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Insurance participation and appointment availability are not established by these public records.

Practice location

2100 Southbridge Pkwy
Birmingham, AL 35209-1317
Professional details: NPI, taxonomy & registry record
NPI1306602651
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
251E00000X
Enumeration date
Feb 26, 2024
Record updated
Apr 7, 2026
More registry details
Provider type
Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

163WH0200X

Specialty details in registry

2278H0200X

Specialty details in registry

2279H0200X

Specialty details in registry

251E00000X · Primary

Specialty details in registry

364SH0200X

Specialty details in registry

374U00000X

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

2100 Southbridge Pkwy
Birmingham, AL 35209-1317
Phone
(719) 517-6905
Fax
(585) 502-1157
Mailing address
4299 SMITH RD

LOGANVILLE, GA 300522504
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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