Basic Information
| Provider Information | |||||||||
| NPI: | 1851439582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METRO WEST MEDICAL GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 PRINCETON AVE SW | ||||||||
| Address2: | POB I SUITE 406 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352111310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057886688 | ||||||||
| FaxNumber: | 2057880305 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 PRINCETON AVE SW | ||||||||
| Address2: | POB I SUITE 406 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352111310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057886688 | ||||||||
| FaxNumber: | 2057880305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 07/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | WILLIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2053979214 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0410343 | 01 | AL | JGL UHC | OTHER | 0101621 | 01 | AL | UHC | OTHER | 0410383 | 01 | AL | JDM UHC | OTHER |