Healthcare Provider Details

I. General information

NPI: 1679827497
Provider Name (Legal Business Name): VALLEY HEAD CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 COUNTY ROAD 88
PISGAH AL
35765
US

IV. Provider business mailing address

PO BOX 246
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 TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MUHAMMAD EJAZ ATA
Title or Position: OWNER
Credential: M.D.
Phone: 256-451-1250