=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326758525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFINITY PRIMARY CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2022
-----------------------------------------------------
Last Update Date | 02/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 AIRPORT RD SW STE C
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35802-1478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-824-9966
-----------------------------------------------------
Fax | 256-242-1022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2120 SPRINGHOUSE RD SE
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35802-1869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-701-1435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ PHYSICIAN
-----------------------------------------------------
Name | PRASANNA KUMAR ALLADA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 256-701-1435
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------