Provider Demographics
NPI:1578823894
Name:ALEXANDER-WALL, AMANDA NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:ALEXANDER-WALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:320 PELHAM AVE SW STE 301
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5051
Mailing Address - Country:US
Mailing Address - Phone:256-759-9269
Mailing Address - Fax:256-759-9187
Practice Address - Street 1:320 PELHAM AVE SW STE 301
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5051
Practice Address - Country:US
Practice Address - Phone:256-759-9269
Practice Address - Fax:256-759-9187
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL43952207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology