Provider Demographics
NPI:1700873825
Name:CORNELIUS, DONALD R (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:CORNELIUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PLZ STE 600
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2659
Mailing Address - Country:US
Mailing Address - Phone:205-709-1337
Mailing Address - Fax:205-267-0220
Practice Address - Street 1:1 INDEPENDENCE PLZ STE 600
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2659
Practice Address - Country:US
Practice Address - Phone:205-709-1337
Practice Address - Fax:205-267-0220
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00007394103T00000X
ALMD.73942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009968405Medicaid
AL51522658OtherBLUE CROSS