Provider Demographics
NPI:1952367377
Name:HANKINS, JERRY BRUCE (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:BRUCE
Last Name:HANKINS
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 1:111 REACH WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8669
Mailing Address - Country:US
Mailing Address - Phone:205-814-0404
Mailing Address - Fax:205-814-0407
Practice Address - Street 1:12 CROPWELL DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35128-7552
Practice Address - Country:US
Practice Address - Phone:205-814-0404
Practice Address - Fax:205-814-0407
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017795208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF90816Medicare UPIN