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General NPI Number Information
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NPI Number | 1306939467
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Entity Type | Organization
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Legal Business Name | MUHAMMAD EJAZ ATA
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 02/10/2009
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Provider Practice Location Address
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Address Line | 6110 COUNTY ROAD 88 PISGAH MEDICAL CLINIC
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City | PISGAH
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State | AL
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Zip | 35765
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Country | US
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Telephone | 256-451-1250
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Fax | 256-451-1270
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Provider Business Mailing Address
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Address Line | PO BOX 246 6110 COUNTY ROAD 88
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City | PISGAH
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State | AL
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Zip | 35765-0246
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Country | US
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Telephone | 256-451-1250
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Fax | 256-451-1270
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MUHAMMAD EJAZ ATA
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Credential | MD
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Telephone | 256-451-1250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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