Provider Demographics
NPI:1154508984
Name:ST.CLAIR, JODY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JODY
Middle Name:
Last Name:ST.CLAIR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 PRINCETON AVE SW
Mailing Address - Street 2:POB II, SUITE 306
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1333
Mailing Address - Country:US
Mailing Address - Phone:205-939-3514
Mailing Address - Fax:
Practice Address - Street 1:817 PRINCETON AVE SW
Practice Address - Street 2:POB II STE. 306
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1333
Practice Address - Country:US
Practice Address - Phone:205-783-0160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-566363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical