1417988452 NPI number — DR. WILLIE JOSEPH CORNAY III M.D.

Table of content: DR. WILLIE JOSEPH CORNAY III M.D. (NPI 1417988452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417988452 NPI number — DR. WILLIE JOSEPH CORNAY III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORNAY
Provider First Name:
WILLIE
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1417988452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
516 BROOKWOOD BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35209-7054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-776-3131
Provider Business Mailing Address Fax Number:
205-776-3132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 BROOKWOOD BLVD STE 100
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:
35209-7054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-776-3131
Provider Business Practice Location Address Fax Number:
205-776-3132
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  11181 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10-10009 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C71183 . This is a "THE OATH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 0515 17063 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 2637460-003 . This is a "CIGNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C71183 . This is a "SENIORS FIRST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4050138 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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