Organization
UAB HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHNATHAN TIDWELL CRNP (NURSE PRACTITIONER)
(205) 975-0512
Entity
Organization
Contact information
Practice address
619 19TH ST. SOUTH, BIRMINGHAM, AL 35294
(205) 975-0512
(205) 975-6404
Mailing address
619 19TH ST. SOUTH, BIRMINGHAM, AL 35294
(205) 975-0512
(205) 975-6404
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
1-124189
AL
Other
Enumeration date
10/22/2015
Last updated
10/22/2015
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