Provider Demographics
NPI:1770536419
Name:GIDLEY, KRISTINA SUMMERS (SA)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:SUMMERS
Last Name:GIDLEY
Suffix:
Gender:F
Credentials:SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BROOKWOOD BLVD
Mailing Address - Street 2:SUITE 372
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6862
Mailing Address - Country:US
Mailing Address - Phone:205-949-1800
Mailing Address - Fax:
Practice Address - Street 1:513 BROOKWOOD BLVD
Practice Address - Street 2:SUITE 372
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6862
Practice Address - Country:US
Practice Address - Phone:205-949-1800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-218207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS96496Medicare UPIN