Healthcare Provider Details

I. General information

NPI: 1285802876
Provider Name (Legal Business Name): KEWAL K VERMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 PELHAM RD S
JACKSONVILLE AL
36265-3312
US

IV. Provider business mailing address

1642 SUITE A PELHAM ROAD SOUTH
JACKSONVILLE AL
36265
US

V. Phone/Fax

Practice location:
  • Phone: 256-365-2233
  • Fax: 256-365-2187
Mailing address:
  • Phone: 256-365-2233
  • Fax: 256-365-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number7306
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7306
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: