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General NPI Number Information
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NPI Number | 1508394586
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Entity Type | Organization
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Legal Business Name | EHTSHAM HAQ
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Dates
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Enumeration Date | 06/02/2017
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Last Update Date | 06/02/2017
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Provider Practice Location Address
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Address Line | 2010 BROOKWOOD MEDICAL CTR DR
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City | BIRMINGHAM
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State | AL
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Zip | 35209-6804
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Country | US
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Telephone | 205-802-1094
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Fax | 205-877-4089
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Provider Business Mailing Address
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Address Line | 630 CAHABA RIVER EST
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City | HOOVER
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State | AL
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Zip | 35244-4402
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Country | US
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Telephone | 205-987-9559
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Fax | 205-877-4089
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Authorized Official
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Title or Position | OWNER/PSYCHIATRIST
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Name | DR. EHTSHAM UL HAQ
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Credential | MD
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Telephone | 205-987-9559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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