Individual
PONGTAWAT LERTWILAIWITTAYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
625 19TH ST S, BIRMINGHAM, AL 35233-1900
(205) 934-9666
Mailing address
625 19TH ST S, BIRMINGHAM, AL 35233-1900
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
47930
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/23/2021
Last updated
07/25/2025
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