Individual
MS. AMANDA M MCANNALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
805 SAINT VINCENTS DR, SUITE 100, BIRMINGHAM, AL 35205-1636
(205) 939-3699
(205) 581-7155
Mailing address
805 SAINT VINCENTS DR, SUITE 100, BIRMINGHAM, AL 35205-1636
(205) 939-3699
(205) 581-7155
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
940
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051545918
BLUE CROSS BLUE SHIELD
AL
01
—
940
NATABOC
AL
Enumeration date
04/02/2007
Last updated
02/16/2011
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