Healthcare Provider Details

I. General information

NPI: 1851372460
Provider Name (Legal Business Name): VALLEY INTERNAL MEDICINE AND PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 WILL HALSEY WAY SUITE A
MADISON AL
35758-2565
US

IV. Provider business mailing address

708 WILL HALSEY WAY SUITE A
MADISON AL
35758-2565
US

V. Phone/Fax

Practice location:
  • Phone: 256-325-7425
  • Fax: 256-325-2465
Mailing address:
  • Phone: 256-325-7425
  • Fax: 256-325-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AKRAM IBRAHIEM HAGGAG
Title or Position: MD
Credential:
Phone: 256-325-7425