Basic Information
| Provider Information | |||||||||
| NPI: | 1790172104 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JERI YVONNE MOVEMENT DISORDERS NEUROLOGY INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55310 | ||||||||
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| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058018000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 6TH AVE S | ||||||||
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| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352332110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058018000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2015 | ||||||||
| LastUpdateDate: | 04/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | JERI | ||||||||
| AuthorizedOfficialMiddleName: | YVONNE | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 2058018000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 31068 | AL | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.