Provider Demographics
NPI:1457795114
Name:UNIVERSITY OF ALABAMA IN BIRMINGHAM
Entity Type:Organization
Organization Name:UNIVERSITY OF ALABAMA IN BIRMINGHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KENESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-996-4047
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-7330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-7330
Practice Address - Country:US
Practice Address - Phone:205-934-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10037934283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital