Healthcare Provider Details

I. General information

NPI: 1457711863
Provider Name (Legal Business Name): ALLERGY & FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 PELHAM RD S SUITE A
JACKSONVILLE AL
36265-3312
US

IV. Provider business mailing address

1642 PELHAM RD S SUITE A
JACKSONVILLE AL
36265-3312
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 TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7306
License Number StateAL

VIII. Authorized Official

Name: DR. KEWAL K VERMA
Title or Position: OWNER
Credential: M.D.
Phone: 256-365-2233