Provider Demographics
NPI:1427438530
Name:ALEKSIDZE, NINO (MD)
Entity type:Individual
Prefix:MS
First Name:NINO
Middle Name:
Last Name:ALEKSIDZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 AFFLINK PL STE 101
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2452
Mailing Address - Country:US
Mailing Address - Phone:205-366-9740
Mailing Address - Fax:
Practice Address - Street 1:300 SAINT LUKES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7102
Practice Address - Country:US
Practice Address - Phone:334-273-8877
Practice Address - Fax:334-273-9733
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2021-11-16
Deactivation Date:2016-01-20
Deactivation Code:
Reactivation Date:2016-04-14
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL42597207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program