# UAB HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740652346
- **Authorized official:** MR. JOHNATHAN TIDWELL CRNP (NURSE PRACTITIONER)
- **Authorized official phone:** (205) 975-0512

## Contact information

- **Practice address:** 619 19TH ST. SOUTH, BIRMINGHAM, AL 35294
- **Practice address phone:** (205) 975-0512
- **Practice address fax:** (205) 975-6404
- **Mailing address:** 619 19TH ST. SOUTH, BIRMINGHAM, AL 35294
- **Mailing address phone:** (205) 975-0512
- **Mailing address fax:** (205) 975-6404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 1-124189 | AL | Yes |

## Other

- **Enumeration date:** 10/22/2015
- **Last updated:** 10/22/2015