Provider Demographics
NPI:1528006970
Name:WOOLVERTON, SELINA GREATHOUSE (PA)
Entity Type:Individual
Prefix:MS
First Name:SELINA
Middle Name:GREATHOUSE
Last Name:WOOLVERTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:SELINA
Other - Middle Name:RENEE
Other - Last Name:GREATHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1325 MCFARLAND BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3270
Mailing Address - Country:US
Mailing Address - Phone:205-333-8800
Mailing Address - Fax:205-333-8406
Practice Address - Street 1:1325 MCFARLAND BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3270
Practice Address - Country:US
Practice Address - Phone:205-333-8800
Practice Address - Fax:205-333-8406
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA269363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51527773OtherALABAMA BLUE CROSS
ALP00393710OtherRAILROAD MEDICARE
AL51527773OtherALABAMA BLUE CROSS
ALP29672Medicare UPIN