Provider Demographics
NPI:1285084087
Name:CHAMIEH, JAD (MD)
Entity type:Individual
Prefix:
First Name:JAD
Middle Name:
Last Name:CHAMIEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 PINE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1109
Mailing Address - Country:US
Mailing Address - Phone:334-293-6858
Mailing Address - Fax:
Practice Address - Street 1:1725 PINE ST STE 201
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1117
Practice Address - Country:US
Practice Address - Phone:334-293-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-3534208600000X
MO2016012955208600000X
AL42610208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery