Healthcare Provider Details

I. General information

NPI: 1922442755
Provider Name (Legal Business Name): MOHAMAD MOUSTAPHA EL KHATIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N CHALKVILLE RD
TRUSSVILLE AL
35173-1376
US

IV. Provider business mailing address

101 FITNESS WAY SUITE 2100
ATHENS AL
35611-2480
US

V. Phone/Fax

Practice location:
  • Phone: 205-847-2780
  • Fax: 205-847-2781
Mailing address:
  • Phone: 256-216-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34406
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: