Healthcare Provider Details

I. General information

NPI: 1508047697
Provider Name (Legal Business Name): NAKI PEDIATRICS & ADOLESCENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BAY ST
GADSDEN AL
35901-5108
US

IV. Provider business mailing address

410 BAY ST NAKI PEDIATRICS & ADOLESCENT HEALTH CENTER, PC
GADSDEN AL
35901-0000
US

V. Phone/Fax

Practice location:
  • Phone: 256-543-0111
  • Fax: 256-543-2907
Mailing address:
  • Phone: 256-543-0111
  • Fax: 256-543-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number8282
License Number StateAL

VIII. Authorized Official

Name: CHRISTOPHER KIRYA
Title or Position: PRESIDENT
Credential: MD
Phone: 256-543-0111