Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 940 | AL |
NPI | 1104947712 |
---|---|
Provider Name | Ms. Amanda M Mcannally |
First Address | Birmingham, AL 35205-1636 |
Second Address | Birmingham, AL 35205-1636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 16/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051545918 | BLUE CROSS BLUE SHIELD (01) | AL |
940 | NATABOC (01) | AL |