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General NPI Number Information
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NPI Number | 1124379839
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Entity Type | Organization
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Legal Business Name | AMMA HEALTH CARE CLINIC LLC
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 302 MAIN ST S
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City | SECTION
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State | AL
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Zip | 35771-7006
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Country | US
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Telephone | 256-259-3778
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Fax | 256-259-3759
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | SCOTTSBORO
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State | AL
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Zip | 35768-0278
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Country | US
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Telephone | 256-259-3778
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Fax | 256-259-3759
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YOUNUS M ISMAIL
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Credential | M.D
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Telephone | 256-259-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 22123
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License Number State | AL
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