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General NPI Number Information
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NPI Number | 1992259501
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Entity Type | Organization
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Legal Business Name | TRANQUIL PSYCHIATRY CLINIC,LLC
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 333 NW 5TH ST APT. NO. 1010
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-3080
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Country | US
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Telephone | 210-430-9196
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Fax | 888-745-3175
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Provider Business Mailing Address
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Address Line | 333 NW 5TH ST APT. NO. 1010
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-3080
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Country | US
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Telephone | 210-430-9196
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Fax | 888-745-3175
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | AZHAR ALI ABDULLAH
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Credential | M.D.
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Telephone | 210-430-9196
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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 | 31992
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License Number State | OK
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