MEDICARE: DR. KEWAL K VERMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	7306	AL
2	207Q00000X	Family Medicine Physician	7306	AL

General Provider Information

NPI Number	:	1285802876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEWAL K VERMA M.D.

Provider Business Mailing Address
First Line	:	1642 SUITE A PELHAM ROAD SOUTH
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265
Country	:	US
Telephone Number	:	256-365-2233
Fax Number	:	256-365-2187

Provider Business Practice Location Address
First Line	:	1642 PELHAM RD S
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-3312
Country	:	US
Telephone Number	:	256-365-2233
Fax Number	:	256-365-2187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	02/19/2016

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