Provider Demographics
NPI:1134885189
Name:GLADWELL, COURTNEY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GLADWELL
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5234
Mailing Address - Country:US
Mailing Address - Phone:205-310-1497
Mailing Address - Fax:
Practice Address - Street 1:4700 RICE MINE RD NE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2647
Practice Address - Country:US
Practice Address - Phone:205-614-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-150741208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics