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NPI Code Detail

MEDICARE: MAIN STREET CLINIC, LLC

MEDICARE: MAIN STREET CLINIC, LLC
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
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1740895291
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAIN STREET CLINIC, LLC
Provider Business Mailing Address
First Line : 1508 COGSWELL AVE
Second Line :
City : PELL CITY
State : AL
Zip : 35125-1243
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1508 COGSWELL AVE
Second Line :
City : PELL CITY
State : AL
Zip : 35125-1243
Country : US
Telephone Number : 256-418-4300
Fax Number : 888-827-8932
Authorized Official
Title or Position : OWNER
Name : MUHAMMAD E ATA
Credential : MD
Telephone Number : 256-418-4300
Provider Enumeration Date : 09/11/2020
Last Update Date : 09/11/2020

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Directions to “MAIN STREET CLINIC, LLC ” Practice Location

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