Healthcare Provider Details

I. General information

NPI: 1922198373
Provider Name (Legal Business Name): CENTRAL ALABAMA KIDNEY AND HYPERTENSION CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4163 LOMAC ST
MONTGOMERY AL
36106-2881
US

IV. Provider business mailing address

4163 LOMAC ST
MONTGOMERY AL
36106-2881
US

V. Phone/Fax

Practice location:
  • Phone: 334-396-5570
  • Fax: 334-396-5572
Mailing address:
  • Phone: 334-396-5570
  • Fax: 334-396-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number10666 AND 17288
License Number StateAL

VIII. Authorized Official

Name: SHIRLEY KROTHAPALLI
Title or Position: OFFICE MANAGER
Credential:
Phone: 334-396-5570