Healthcare Provider Details

I. General information

NPI: 1902987431
Provider Name (Legal Business Name): AHMAD SHIKHTHOLTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 DANVILLE RD SW SUITE G
DECATUR AL
35601-4603
US

IV. Provider business mailing address

PO BOX 5038
DECATUR AL
35601-0038
US

V. Phone/Fax

Practice location:
  • Phone: 256-301-9994
  • Fax: 256-301-5545
Mailing address:
  • Phone: 256-301-9994
  • Fax: 256-301-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number27458
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: