Provider Demographics
NPI:1023815628
Name:BIRMINGHAM FUNCTIONAL NEUROLOGY, LLC
Entity type:Organization
Organization Name:BIRMINGHAM FUNCTIONAL NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FUNCTIONAL NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:B
Authorized Official - Last Name:ARRIETA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, DC, DACNB
Authorized Official - Phone:205-882-1348
Mailing Address - Street 1:817 PRINCETON AVE SW STE 112
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1340
Mailing Address - Country:US
Mailing Address - Phone:205-882-1348
Mailing Address - Fax:205-882-1348
Practice Address - Street 1:817 PRINCETON AVE SW STE 112
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1340
Practice Address - Country:US
Practice Address - Phone:205-882-1348
Practice Address - Fax:205-882-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1649884750Medicaid