Individual
CARROLTON MACKENZIE STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
619 19TH ST S, BIRMINGHAM, AL 35233-1900
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2774
AL
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/29/2024
Last updated
02/24/2026
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