Active NPI
Timothy Connolly
- Specialist
- Birmingham, AL
National Provider Identifier
1083031975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- L3980F
- Practice address
- 1720 2ND Avneue S
BDB 563
Birmingham, AL 35294-0012 - Phone
- (205) 934-9767
- Fax
- (205) 934-3993
- NPI assigned
- Mar 28, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | L3980F | AL | Primary |
Addresses
Primary practice location
1720 2ND Avneue S
BDB 563
Birmingham, AL 35294-0012
Mailing address
1300 27TH PL S
Apt. 14
Birmingham, AL 35205-2567
Phone (205) 934-9767
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L3980F | AL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395964800000",
"number": "1083031975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 27TH PL S",
"address_2": "APT. 14",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352052567",
"telephone_number": "205-934-9767",
"fax_number": "205-934-3993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1720 2ND AVNEUE S",
"address_2": "BDB 563",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352940012",
"telephone_number": "205-934-9767",
"fax_number": "205-934-3993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "TIMOTHY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-03-28",
"last_updated": "2014-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AL",
"license": "L3980F",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.