Healthcare Provider Details

I. General information

NPI: 1831293117
Provider Name (Legal Business Name): MUHAMMAD EJAZ ATA, M.D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 HARLEY ST SCOTTSBORO MEDICAL CLINIC
SCOTTSBORO AL
35768-4219
US

IV. Provider business mailing address

PO BOX 246
PISGAH AL
35765-0246
US

V. Phone/Fax

Practice location:
  • Phone: 256-574-6157
  • Fax: 256-259-0560
Mailing address:
  • Phone: 256-451-1250
  • Fax: 256-451-1270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24327
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26901
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24797
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16386
License Number StateAL

VIII. Authorized Official

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