Healthcare Provider Details

I. General information

NPI: 1083819924
Provider Name (Legal Business Name): HUMA KHUSRO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BAY ST
GADSDEN AL
35901-5229
US

IV. Provider business mailing address

106 BAY ST
GADSDEN AL
35901-5229
US

V. Phone/Fax

Practice location:
  • Phone: 256-547-7778
  • Fax: 256-547-7709
Mailing address:
  • Phone: 256-547-7778
  • Fax: 256-547-7709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number19471
License Number StateAL

VIII. Authorized Official

Name: DR. HUMA KHUSRO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 256-547-7778