Provider Demographics
NPI:1689734550
Name:MYRICK, ANDREW JACKSON JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JACKSON
Last Name:MYRICK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W LAKESHORE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7271
Mailing Address - Country:US
Mailing Address - Phone:205-930-2950
Mailing Address - Fax:205-930-2957
Practice Address - Street 1:1 W LAKESHORE DR STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-7271
Practice Address - Country:US
Practice Address - Phone:205-930-2950
Practice Address - Fax:205-930-2957
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051039775OtherBLUE CROSS BLUE SHIELD
C70910Medicare UPIN
AL051039775OtherBLUE CROSS BLUE SHIELD