Provider Demographics
NPI:1427143825
Name:WOOLLEY, AUDIE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:AUDIE
Middle Name:LEE
Last Name:WOOLLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 TANGLEWOOD BROOK LANE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243
Mailing Address - Country:US
Mailing Address - Phone:205-969-6008
Mailing Address - Fax:
Practice Address - Street 1:1940 ELMER J. BISSELL ROAD
Practice Address - Street 2:
Practice Address - City:BRIMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-824-4949
Practice Address - Fax:205-824-4983
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18970207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1010245OtherUNITED HEALTHCARE
AL25457OtherSOUTHERN HEALTH SERVICES
4022OtherHEALTH SPRING OF AL
AL51041710Medicare ID - Type UnspecifiedCHILDREN'S SOUTH
ALE56501Medicare UPIN
AL51045533Medicare Oscar/Certification