Provider Demographics
NPI:1851439582
Name:METRO WEST MEDICAL GROUP PC
Entity Type:Organization
Organization Name:METRO WEST MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:205-397-9214
Mailing Address - Street 1:801 PRINCETON AVE SW
Mailing Address - Street 2:POB I SUITE 406
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1310
Mailing Address - Country:US
Mailing Address - Phone:205-788-6688
Mailing Address - Fax:205-788-0305
Practice Address - Street 1:801 PRINCETON AVE SW
Practice Address - Street 2:POB I SUITE 406
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1310
Practice Address - Country:US
Practice Address - Phone:205-788-6688
Practice Address - Fax:205-788-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0410343OtherJGL UHC
AL0101621OtherUHC
AL0410383OtherJDM UHC
AL0101621OtherUHC
ALG91272Medicare UPIN
ALI083Medicare PIN