MEDICARE: KHAWLA SUHAILA MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	MD.50314	AL

General Provider Information

NPI Number	:	1396432019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHAWLA SUHAILA MD

Provider Business Mailing Address
First Line	:	405 BELCHER ST
Second Line	:
City	:	CENTREVILLE
State	:	AL
Zip	:	35042-2946
Country	:	US
Telephone Number	:	205-926-2992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 11TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-3423
Country	:	US
Telephone Number	:	205-996-2671
Fax Number	:

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

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	04/06/2026

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Directions to “ KHAWLA SUHAILA MD” Practice Location

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