Provider Demographics
NPI:1851168900
Name:RUDOLPH JR., TYRONE JR (NBH-HWC)
Entity Type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:
Last Name:RUDOLPH JR.
Suffix:JR
Gender:M
Credentials:NBH-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-1537
Mailing Address - Country:US
Mailing Address - Phone:205-882-7453
Mailing Address - Fax:
Practice Address - Street 1:110 12TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-1537
Practice Address - Country:US
Practice Address - Phone:205-882-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3630565171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach