Healthcare Provider Details

I. General information

NPI: 1174668651
Provider Name (Legal Business Name): DIGESTIVE DISEASE SPECIALISTS OF N.E. ALABAMA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GOODYEAR AVE SUITE A
GADSDEN AL
35903-1107
US

IV. Provider business mailing address

900 GOODYEAR AVE SUITE A
GADSDEN AL
35903-1107
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-3220
  • Fax: 256-492-3759
Mailing address:
  • Phone: 256-492-3220
  • Fax: 256-492-3759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: VIJAYAPRASAD TUMMALA
Title or Position: PARTNER
Credential: M.D.
Phone: 256-492-3220