=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326116468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UROLOGIC CLINICS OF NORTH ALABAMA PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 11/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3201 SW 34TH ST STE F
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34474-7439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-398-4276
-----------------------------------------------------
Fax | 352-291-0087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 COVESHIRE PL
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-3150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-398-4276
-----------------------------------------------------
Fax | 352-291-0087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AMIT CHAKRABARTY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 256-797-8262
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------