Provider Demographics
NPI:1457711863
Name:ALLERGY & FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:ALLERGY & FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEWAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:VERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-365-2233
Mailing Address - Street 1:1642 PELHAM RD S
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3312
Mailing Address - Country:US
Mailing Address - Phone:256-365-2233
Mailing Address - Fax:256-365-2187
Practice Address - Street 1:1642 PELHAM RD S
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3312
Practice Address - Country:US
Practice Address - Phone:256-365-2233
Practice Address - Fax:256-365-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC72876Medicare UPIN