Healthcare Provider Details

I. General information

NPI: 1053870105
Provider Name (Legal Business Name): SARAH AMANULLAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 MITYLENE PARK DR
MONTGOMERY AL
36117-3548
US

IV. Provider business mailing address

2800 ROSS CLARK CIR
DOTHAN AL
36301-2040
US

V. Phone/Fax

Practice location:
  • Phone: 334-260-8511
  • Fax: 334-260-8755
Mailing address:
  • Phone: 334-793-2211
  • Fax: 334-793-7161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number48985
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: