Provider Demographics
NPI:1043261969
Name:MIXON, JOEL ASHBY (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ASHBY
Last Name:MIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:205-297-9411
Practice Address - Street 1:800 MONTCLAIR ROAD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1908
Practice Address - Country:US
Practice Address - Phone:205-592-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL249312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942569Medicaid
AL009943062Medicaid
AL051540571OtherBLUE CROSS
AL051541323OtherBLUE CROSS
AL171076Medicaid
AL4386037OtherAETNA
AL515-90339OtherBLUE CROSS
AL113976Medicaid
AL511-60929OtherBLUE CROSS
AL515-42990OtherBLUE CROSS
AL009942828Medicaid
ALI53512Medicare UPIN
AL009942569Medicaid
AL009942828Medicaid
AL051540571Medicare PIN