Provider Demographics
NPI:1790023810
Name:BROOKWOOD MATERNAL FETAL MEDICINE
Entity Type:Organization
Organization Name:BROOKWOOD MATERNAL FETAL MEDICINE
Other - Org Name:BROOKWOOD MATERNAL FETAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:MS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:205-877-5113
Mailing Address - Street 1:2006 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:SUITE 604; WMP
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6899
Mailing Address - Country:US
Mailing Address - Phone:205-877-5113
Mailing Address - Fax:205-877-5130
Practice Address - Street 1:2006 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 604; WMP
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6899
Practice Address - Country:US
Practice Address - Phone:205-877-5113
Practice Address - Fax:205-877-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-123626363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty