Healthcare Provider Details

I. General information

NPI: 1912904913
Provider Name (Legal Business Name): AJIT KAMALAKARRAO NAIDU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 FLORENCE BLVD
FLORENCE AL
35630-2751
US

IV. Provider business mailing address

2095 FLORENCE BLVD
FLORENCE AL
35630-2751
US

V. Phone/Fax

Practice location:
  • Phone: 256-766-2310
  • Fax: 256-768-9956
Mailing address:
  • Phone: 256-766-2310
  • Fax: 256-768-9956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15209R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME 97412
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.29028
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: