Healthcare Provider Details

I. General information

NPI: 1558015453
Provider Name (Legal Business Name): DR. PRAMOD BHATIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MEDICAL PARK OFC PARK
TALLADEGA AL
35160-2213
US

IV. Provider business mailing address

PO BOX 622
GARDENDALE AL
35071-0622
US

V. Phone/Fax

Practice location:
  • Phone: 256-761-1729
  • Fax:
Mailing address:
  • Phone: 205-694-2019
  • Fax: 205-631-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State

VIII. Authorized Official

Name: PRAMOD BHATIA
Title or Position: PROVIDER
Credential: MD
Phone: 256-761-1729