Individual
LEONA COUNCIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
619 19TH ST S, BIRMINGHAM, AL 35249-1900
(205) 934-5038
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35233-5310
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
27055
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051548749
BCBS
AL
01
—
051548750
BCBS
AL
01
—
051548751
BCBS
AL
05
—
101636
—
AL
05
—
101637
—
AL
05
—
101638
—
AL
Enumeration date
05/23/2007
Last updated
08/04/2011
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