Healthcare Provider Details

I. General information

NPI: 1851308910
Provider Name (Legal Business Name): MUHAMMAD EJAZ ATA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 COUNTY ROAD 88 PISGAH MEDICAL CLINIC
PISGAH AL
35765
US

IV. Provider business mailing address

PO BOX 246 6110 COUNTY ROAD 88
PISGAH AL
35765
US

V. Phone/Fax

Practice location:
  • Phone: 256-451-1250
  • Fax: 256-451-1270
Mailing address:
  • Phone: 256-451-1250
  • Fax: 256-451-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00000
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00000
License Number StateMD

VIII. Authorized Official

Name: MUHAMMAD EJAZ ATA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 256-451-1250