Provider Demographics
NPI:1174841498
Name:FETTIG, CHRISTINA BAILEY (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:BAILEY
Last Name:FETTIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-1900
Mailing Address - Country:US
Mailing Address - Phone:205-870-1273
Mailing Address - Fax:205-870-1276
Practice Address - Street 1:3401 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-1900
Practice Address - Country:US
Practice Address - Phone:205-870-1273
Practice Address - Fax:205-870-1276
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31445208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-36794OtherBLUE CROSS BLUE SHIELD
AL150926Medicaid