Healthcare Provider Details

I. General information

NPI: 1083955173
Provider Name (Legal Business Name): PREMIER MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 BURLINGTON STREET
SCOTTSBORO AL
35768
US

IV. Provider business mailing address

PO BOX 56
SCOTTSBORO AL
35768
US

V. Phone/Fax

Practice location:
  • Phone: 256-259-1886
  • Fax:
Mailing address:
  • Phone: 256-259-1886
  • Fax:

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 StateAL

VIII. Authorized Official

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