Provider Demographics
NPI:1912118456
Name:NORTH ALABAMA PRIMARY CARE,PC
Entity type:Organization
Organization Name:NORTH ALABAMA PRIMARY CARE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KONERU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-232-2505
Mailing Address - Street 1:1015 HIGHWAY 72 EAST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611
Mailing Address - Country:US
Mailing Address - Phone:256-232-2505
Mailing Address - Fax:256-230-3226
Practice Address - Street 1:1015 HIGHWAY 72 EAST
Practice Address - Street 2:SUITE 1
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611
Practice Address - Country:US
Practice Address - Phone:256-232-2505
Practice Address - Fax:256-230-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCI3887OtherRAILROAD MEDICARE
ALCI3887OtherRAILROAD MEDICARE