Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 1-153516 | AL |
NPI | 1174170963 |
---|---|
Provider Name | Adeline Phillips |
First Address | Birmingham, AL 35212-4038 |
Second Address | Birmingham, AL 35233-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2019 |
Last Update Date | 26/08/2019 |