Provider Demographics
NPI:1003102385
Name:CENTRAL ALABMA PODIATRY, INC.
Entity Type:Organization
Organization Name:CENTRAL ALABMA PODIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEPORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:205-394-0308
Mailing Address - Street 1:1800 MCFARLAND BLVD N
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2114
Mailing Address - Country:US
Mailing Address - Phone:205-759-2851
Mailing Address - Fax:205-759-2853
Practice Address - Street 1:1800 MCFARLAND BLVD N
Practice Address - Street 2:SUITE 220
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2114
Practice Address - Country:US
Practice Address - Phone:205-759-2851
Practice Address - Fax:205-759-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL143213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty