Healthcare Provider Details

I. General information

NPI: 1528215811
Provider Name (Legal Business Name): ASHISH ATULBHAI VYAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 E SOUTH BLVD SUITE 201
MONTGOMERY AL
36116-2458
US

IV. Provider business mailing address

301 BROWN SPRINGS RD
MONTGOMERY AL
36117-7005
US

V. Phone/Fax

Practice location:
  • Phone: 334-747-7250
  • Fax: 334-747-7270
Mailing address:
  • Phone: 334-747-4159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number32734
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: