Healthcare Provider Details

I. General information

NPI: 1659799690
Provider Name (Legal Business Name): MOHAMMAD RAHEEL N JAJJA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 02/01/2024
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35249-1059
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-4011
  • Fax:
Mailing address:
  • Phone: 205-801-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number42254
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: