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General NPI Number Information
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NPI Number | 1508051350
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Entity Type | Organization
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Legal Business Name | DR. PHOHA
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 1321 MCFARLAND BLVD E # 100
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City | TUSCALOOSA
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State | AL
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Zip | 35404-3839
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Country | US
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Telephone | 205-331-7781
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Fax | 205-758-8880
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Provider Business Mailing Address
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Address Line | PO BOX 41027
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City | TUSCALOOSA
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State | AL
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Zip | 35404-7027
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Country | US
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Telephone | 205-331-7781
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Fax | 205-758-8880
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. RAJ L. PHOHA
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Credential |
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Telephone | 205-331-7781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 000893
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License Number State | AL
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