Provider Demographics
NPI:1073606042
Name:SPARKS, JIMMY MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:MITCHELL
Last Name:SPARKS
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 1:2006 BROOKWOOD MEDICAL CENTER DRIVE
Mailing Address - Street 2:STE 700
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-397-1286
Mailing Address - Fax:205-397-1340
Practice Address - Street 1:2006 BROOKWOOD MEDICAL CENTER DRIVE
Practice Address - Street 2:STE 700
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-397-1286
Practice Address - Fax:205-397-1340
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11332207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51098587OtherBCBS OF AL
AL000084452Medicaid
AL1358121OtherUNITED HEALTHCARE
C75025Medicare UPIN
AL000084452Medicaid