Provider Demographics
NPI:1588917728
Name:DISABILITY DETERMINATION SERVICE ST OF AL
Entity type:Organization
Organization Name:DISABILITY DETERMINATION SERVICE ST OF AL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-989-2100
Mailing Address - Street 1:2545 ROCKY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4836
Mailing Address - Country:US
Mailing Address - Phone:205-989-2100
Mailing Address - Fax:
Practice Address - Street 1:2545 ROCKY RIDGE LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-4836
Practice Address - Country:US
Practice Address - Phone:205-989-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPT OF EDUCATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty