Provider Demographics
NPI:1306939467
Name:MUHAMMAD EJAZ ATA
Entity type:Organization
Organization Name:MUHAMMAD EJAZ ATA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:EJAZ
Authorized Official - Last Name:ATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-451-1250
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:6110 COUNTY ROAD 88
Mailing Address - City:PISGAH
Mailing Address - State:AL
Mailing Address - Zip Code:35765-0246
Mailing Address - Country:US
Mailing Address - Phone:256-451-1250
Mailing Address - Fax:256-451-1270
Practice Address - Street 1:6110 COUNTY ROAD 88
Practice Address - Street 2:PISGAH MEDICAL CLINIC
Practice Address - City:PISGAH
Practice Address - State:AL
Practice Address - Zip Code:35765
Practice Address - Country:US
Practice Address - Phone:256-451-1250
Practice Address - Fax:256-451-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCM0511OtherRAILROAD MEDICARE
011432OtherBLUE CROSS OF ALABAMA
AL541003864Medicaid
AL541003864Medicaid