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General NPI Number Information
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NPI Number | 1871085415
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Entity Type | Organization
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Legal Business Name | ALABAMA SURGICAL ARTS, LLC
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 4590 WOODMERE BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106-2918
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Country | US
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Telephone | 334-271-4523
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Fax | 334-271-2002
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Provider Business Mailing Address
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Address Line | 4590 WOODMERE BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106-2918
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Country | US
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Telephone | 334-271-2002
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SAMI ADAM NIZAM II
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Credential | DMD, MD
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Telephone | 334-271-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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