1811971831 NPI number — DR. GEORGE L JOE M.D.

Table of content: DR. GEORGE L JOE M.D. (NPI 1811971831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811971831 NPI number — DR. GEORGE L JOE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOE
Provider First Name:
GEORGE
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1811971831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2016 STONEGATE TRAIL
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
VESTAVIA HILLS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-2260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-545-9530
Provider Business Mailing Address Fax Number:
205-545-9529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MEDICAL PARK DR E
Provider Second Line Business Practice Location Address:
ST. VINCENT'S EAST
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235-3401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-545-9530
Provider Business Practice Location Address Fax Number:
205-545-9529
Provider Enumeration Date:
12/02/2005

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: 207P00000X , with the licence number:  00008153 , 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: 0009977300 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351890800 . This is a "DEPT OF LABOR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C144 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 631257475 . This is a "TAX ID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C141 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529905830 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 604336100 . This is a "DEPT OF LABOR" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: CH5239 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529910000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK8418 . This is a "RR MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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