Provider Demographics
NPI:1467526442
Name:VANCE, KATISHA T (MD)
Entity Type:Individual
Prefix:DR
First Name:KATISHA
Middle Name:T
Last Name:VANCE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:500 OFFICE PARK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2437
Mailing Address - Country:US
Mailing Address - Phone:205-803-4330
Mailing Address - Fax:205-803-4354
Practice Address - Street 1:833 PRINCETON AVE SW STE 105A
Practice Address - Street 2:POB III
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1323
Practice Address - Country:US
Practice Address - Phone:205-786-6983
Practice Address - Fax:205-786-6987
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-06-04
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Provider Licenses
StateLicense IDTaxonomies
AL24465207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051556668Medicaid
AL051556668Medicaid
ALH83002Medicare UPIN