Healthcare Provider Details

I. General information

NPI: 1568579985
Provider Name (Legal Business Name): MERIT HEALTH CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 JAMES PAYTON BLVD
SYLACAUGA AL
35150-8047
US

IV. Provider business mailing address

PO BOX 2038
SYLACAUGA AL
35150-5038
US

V. Phone/Fax

Practice location:
  • Phone: 256-249-0028
  • Fax: 256-249-0019
Mailing address:
  • Phone: 256-249-0028
  • Fax: 256-249-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number17714
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA0512010
License Number StateAL

VIII. Authorized Official

Name: DR. GHAYAS ALI HABACH
Title or Position: OWNER
Credential: M.D., M.P.H.
Phone: 256-249-0028