Healthcare Provider Details

I. General information

NPI: 1184090656
Provider Name (Legal Business Name): WARDA NIAZ MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 PINE ST STE 203
MONTGOMERY AL
36106-1154
US

IV. Provider business mailing address

1722 PINE ST STE 203
MONTGOMERY AL
36106-1158
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-8877
  • Fax: 334-293-6803
Mailing address:
  • Phone: 334-293-8736
  • Fax: 334-293-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD.40968
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: