Healthcare Provider Details

I. General information

NPI: 1871085415
Provider Name (Legal Business Name): ALABAMA SURGICAL ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4590 WOODMERE BLVD
MONTGOMERY AL
36106-2918
US

IV. Provider business mailing address

4590 WOODMERE BLVD
MONTGOMERY AL
36106-2918
US

V. Phone/Fax

Practice location:
  • Phone: 334-271-4523
  • Fax: 334-271-2002
Mailing address:
  • Phone: 334-271-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMI ADAM NIZAM II
Title or Position: MANAGER
Credential: DMD, MD
Phone: 334-271-2002