Provider Demographics
NPI:1073601340
Name:AMJAD, MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:AMJAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 S BROAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2668
Mailing Address - Country:US
Mailing Address - Phone:256-259-3600
Mailing Address - Fax:256-259-3601
Practice Address - Street 1:1508 S BROAD ST STE 300
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2668
Practice Address - Country:US
Practice Address - Phone:256-259-3600
Practice Address - Fax:256-259-3601
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009907805Medicaid
AL1073601340Medicaid
AL1376966416OtherGROUP NPI
AL1021377281OtherMEDICARE PTAN
AL155726Medicaid
AL51597531OtherBLUE CROSS
AL156513Medicaid
AL155726Medicaid
AL009907805Medicaid
AL1073601340Medicaid
AL1376966416OtherGROUP NPI
AL051552241Medicare PIN
H67439Medicare UPIN