Provider Demographics
NPI:1902216203
Name:RUDOLPH BOLLING PSYCHIATRY PC
Entity Type:Organization
Organization Name:RUDOLPH BOLLING PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUDOLPH BOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-828-1402
Mailing Address - Street 1:201 BEACON PKWY W STE 201
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 BEACON PKWY W STE 201
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-3129
Practice Address - Country:US
Practice Address - Phone:615-828-1402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30986261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health