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General NPI Number Information
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NPI Number | 1407042740
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Entity Type | Organization
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Legal Business Name | EAST ALABAMA NEUROLOGY INC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 3120 FREDERICK RD SUITE I
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City | OPELIKA
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State | AL
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Zip | 36801-7134
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Country | US
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Telephone | 334-887-0955
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Fax | 334-887-0964
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Provider Business Mailing Address
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Address Line | 3120 FREDERICK RD STE I
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City | OPELIKA
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State | AL
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Zip | 36801-7135
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Country | US
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Telephone | 334-887-0955
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Fax | 334-887-0964
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KRISHNA KISHORE CHIVUKULA
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Credential | M.D.
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Telephone | 334-887-0955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3874
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License Number State | AL
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