Healthcare Provider Details

I. General information

NPI: 1336328533
Provider Name (Legal Business Name): WEST ALABAMA PSYCHIATRIC ASSOCIATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4804 HIGHWAY 69 N
NORTHPORT AL
35473-2035
US

IV. Provider business mailing address

4804 HIGHWAY 69 N
NORTHPORT AL
35473-2035
US

V. Phone/Fax

Practice location:
  • Phone: 205-330-7700
  • Fax: 205-330-7718
Mailing address:
  • Phone: 205-330-7700
  • Fax: 205-330-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number791051
License Number StateAL

VIII. Authorized Official

Name: M O MOHABBAT
Title or Position: OWNER
Credential: M.D.
Phone: 205-330-7700