Provider Demographics
NPI:1033388970
Name:SYLACAUGA INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:SYLACAUGA INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDALLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELKHIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-249-0061
Mailing Address - Street 1:PO BOX 2419
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-5419
Mailing Address - Country:US
Mailing Address - Phone:256-249-0061
Mailing Address - Fax:256-249-2033
Practice Address - Street 1:310 W FORT WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2434
Practice Address - Country:US
Practice Address - Phone:256-249-0061
Practice Address - Fax:256-249-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH07998Medicare UPIN