Healthcare Provider Details

I. General information

NPI: 1659561983
Provider Name (Legal Business Name): NORTH ALABAMA MEDICAL ASSOCIATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S 5TH ST
GADSDEN AL
35901-4217
US

IV. Provider business mailing address

PO BOX 523
JENISON MI
49429-0523
US

V. Phone/Fax

Practice location:
  • Phone: 256-543-2867
  • Fax:
Mailing address:
  • Phone: 616-457-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.638
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberDO.637
License Number StateAL

VIII. Authorized Official

Name: DR. KURT K KANTZLER
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 256-543-2867