Healthcare Provider Details

I. General information

NPI: 1326100215
Provider Name (Legal Business Name): CHILD NEUROLOGY & SEIZURE SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 HOSPITAL DR SUITE 200
NORTHPORT AL
35476-3376
US

IV. Provider business mailing address

2702 HOSPITAL DR SUITE 200
NORTHPORT AL
35476-3376
US

V. Phone/Fax

Practice location:
  • Phone: 205-333-7075
  • Fax: 205-333-3256
Mailing address:
  • Phone: 205-333-7075
  • Fax: 205-333-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number17109
License Number StateAL

VIII. Authorized Official

Name: DR. ASHRAF AHSAN SYED
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-333-7075