Provider Demographics
NPI:1154983443
Name:AIDS ALABAMA INC
Entity type:Organization
Organization Name:AIDS ALABAMA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:205-310-8051
Mailing Address - Street 1:3521 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3210
Mailing Address - Country:US
Mailing Address - Phone:205-324-9822
Mailing Address - Fax:205-324-9881
Practice Address - Street 1:3522 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35222-3211
Practice Address - Country:US
Practice Address - Phone:205-324-9822
Practice Address - Fax:205-324-9881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIDS ALABAMA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-08
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty