Healthcare Provider Details

I. General information

NPI: 1306939467
Provider Name (Legal Business Name): MUHAMMAD EJAZ ATA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/10/2009
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
35765-0246
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 TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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