Provider Demographics
NPI:1235880402
Name:RHODA, AUTUMN BROOKE
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:BROOKE
Last Name:RHODA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 STERLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2070
Mailing Address - Country:US
Mailing Address - Phone:901-212-7836
Mailing Address - Fax:
Practice Address - Street 1:3700 CAHABA BEACH RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5225
Practice Address - Country:US
Practice Address - Phone:208-820-5421
Practice Address - Fax:205-278-7660
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant