Provider Information for 1417502089
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PERCY STOREY III
Sex: Male
NPI: 1417502089
Last Updated: 2023-10-18
Certification Date: 2023-10-18
Certification Date: 2023-10-18
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1417502089 | ||||||||||||
| Enumeration Date | 2019-08-09 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 150 GLENWOOD LN BIRMINGHAM, AL 35242-5700 United States Phone: 205-969-1088 | Fax:205-795-3390 | ||||||||||||
| Primary Practice Address | 150 GLENWOOD LN BIRMINGHAM, AL 35242-5700 United States Phone: 205-969-1088 | Fax:205-795-3390 | ||||||||||||
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