Provider Demographics
NPI:1750433181
Name:SNOW, KELLEY (MD)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:SNOW
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 1:985 9TH AVE SW
Mailing Address - Street 2:STE. 507
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35023-7814
Mailing Address - Country:US
Mailing Address - Phone:205-481-7577
Mailing Address - Fax:205-481-7580
Practice Address - Street 1:985 9TH AVE SW
Practice Address - Street 2:STE. 507
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35023
Practice Address - Country:US
Practice Address - Phone:205-481-7577
Practice Address - Fax:205-481-7580
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000018743Medicaid
200041630OtherMEDICARE RAILROAD IND.
DD6433OtherMEDICARE RAILROAD GROUP
051556679Medicare PIN
ALC75509Medicare UPIN
DD6433OtherMEDICARE RAILROAD GROUP