Basic Information
| Provider Information | |||||||||
| NPI: | 1770642936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGY ASSOCIATES OF WEST ALABAMA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 403643 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303843643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006476889 | ||||||||
| FaxNumber: | 6152616052 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 UNIVERSITY BLVD E | ||||||||
| Address2: | STE 908 | ||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354012086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053449393 | ||||||||
| FaxNumber: | 2057586750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | ALDRIDGE | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 2053449393 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 000740 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.