Provider Demographics
NPI:1568497493
Name:SALTER-BLACKWELL, SALLY PULLEN (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:PULLEN
Last Name:SALTER-BLACKWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:PULLEN
Other - Last Name:SALTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 55361
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5361
Mailing Address - Country:US
Mailing Address - Phone:205-933-6440
Mailing Address - Fax:205-933-6442
Practice Address - Street 1:2700 10TH AVE S STE 402
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1250
Practice Address - Country:US
Practice Address - Phone:205-933-6440
Practice Address - Fax:205-933-6442
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21468208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710568OtherUNITED HEALTH CARE
ALSA051502091Medicaid
AL051502091SALOtherBLUE CROSS
051502091SALMedicare ID - Type Unspecified
AL051502091SALOtherBLUE CROSS