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General NPI Number Information
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NPI Number | 1578962932
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Entity Type | Organization
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Legal Business Name | ALABAMA CHILDREN'S CLINIC
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 333 WHITESPORT DR SW SUITE 104
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6454
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Country | US
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Telephone | 256-880-0376
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Fax | 256-880-0395
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Provider Business Mailing Address
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Address Line | 333 WHITESPORT DR SW SUITE 104
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6454
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Country | US
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Telephone | 256-880-0376
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Fax | 256-880-0395
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. NASENDRA RAO THOTAHURD
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Credential | M.D
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Telephone | 256-880-0376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 12774
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License Number State | AL
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