Healthcare Provider Details

I. General information

NPI: 1184185233
Provider Name (Legal Business Name): SAMMY HAMOOD YASSIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 2ND AVE S
BIRMINGHAM AL
35294-0004
US

IV. Provider business mailing address

1720 2ND AVE S
BIRMINGHAM AL
35294-0004
US

V. Phone/Fax

Practice location:
  • Phone: 205-239-9263
  • Fax:
Mailing address:
  • Phone: 205-239-9263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number1-166358
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: