Individual
ELIZABETH CHILDRESS WESTERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
701 UNIVERSITY BLVD E, SUITE 507, TUSCALOOSA, AL 35401-7432
(205) 330-3650
(205) 330-3655
Mailing address
701 UNIVERSITY BLVD E, SUITE 507, TUSCALOOSA, AL 35401-7432
(205) 330-3650
(205) 330-3655
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30931
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102G701388
MEDICARE-GROUP
AL
01
—
102I081387
MEDICARE-INDIV.
AL
01
—
138413
MEDICAID-GROUP
AL
01
—
138652
MEDICAID INDIV.
AL
01
—
511-27182
BC/BS OF AL
AL
Enumeration date
12/17/2009
Last updated
09/17/2012
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