1043261969 NPI number — JOEL ASHBY MIXON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043261969 NPI number — JOEL ASHBY MIXON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MIXON

Provider First Name:

JOEL

Provider Middle Name:

ASHBY

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1043261969

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/15/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 55310

Provider Second Line Business Mailing Address:

STE 300

Provider Business Mailing Address City Name:

BIRMINGHAM

Provider Business Mailing Address State Name:

AL

Provider Business Mailing Address Postal Code:

35255-5310

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

205-731-9701

Provider Business Mailing Address Fax Number:

205-297-9411

Provider First Line Business Practice Location Address:

800 MONTCLAIR ROAD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BIRMINGHAM

Provider Business Practice Location Address State Name:

AL

Provider Business Practice Location Address Postal Code:

35213-1908

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

205-592-1000

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

05/15/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  24931 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 009942569 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 009943062 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 051540571 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 051541323 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 171076 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 4386037 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 515-90339 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 113976 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 511-60929 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 515-42990 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 009942828 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".