Basic Information
| Provider Information | |||||||||
| NPI: | 1942331863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHC-PRINCETON PSYCHIATRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 PRINCETON AVE SW | ||||||||
| Address2: | GESTETNER BUILDING 636 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352111303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057837871 | ||||||||
| FaxNumber: | 2057837876 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 BEACON PKWY W | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352093102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057155910 | ||||||||
| FaxNumber: | 2057155928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 10/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | FAULKNER | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2057155901 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAPTIST HEALTH CENTERS, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.