Healthcare Provider Details

I. General information

NPI: 1427438530
Provider Name (Legal Business Name): NINO ALEKSIDZE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date: 01/20/2016
Reactivation Date: 04/14/2016

III. Provider practice location address

4145 CARMICHAEL RD
MONTGOMERY AL
36106-2803
US

IV. Provider business mailing address

4145 CARMICHAEL RD
MONTGOMERY AL
36106-2803
US

V. Phone/Fax

Practice location:
  • Phone: 334-273-7000
  • Fax:
Mailing address:
  • Phone: 334-273-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number42597
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: