Provider Demographics
NPI:1104653062
Name:DERMA BIRMINGHAM LLC
Entity type:Organization
Organization Name:DERMA BIRMINGHAM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:MARCHIONY
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-825-5575
Mailing Address - Street 1:2142 TYLER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1307
Mailing Address - Country:US
Mailing Address - Phone:205-825-5575
Mailing Address - Fax:205-825-5576
Practice Address - Street 1:2142 TYLER RD STE 110
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-1307
Practice Address - Country:US
Practice Address - Phone:205-825-5575
Practice Address - Fax:205-825-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL341871Medicaid
1104653062OtherNPI GROUP
1477932192OtherNPI
AL237277Medicaid
AL342122Medicaid