Provider Demographics
NPI:1619988326
Name:PULMONARY AND SLEEP ASSOC OF ALABAMA
Entity Type:Organization
Organization Name:PULMONARY AND SLEEP ASSOC OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:205-871-9112
Mailing Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:ACC # 310
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6808
Mailing Address - Country:US
Mailing Address - Phone:205-871-9112
Mailing Address - Fax:205-871-9114
Practice Address - Street 1:2022 BROOKWOOD MEDICAL CT DR
Practice Address - Street 2:ACC 310
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6808
Practice Address - Country:US
Practice Address - Phone:205-871-9112
Practice Address - Fax:205-871-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10748207RP1001X
AL24068207RP1001X
AL14068207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529914500Medicaid
AL8416121712OtherTAX IDENTIFICATION NUMBER
AL8416121712OtherTAX IDENTIFICATION NUMBER