Provider Demographics
NPI:1124379839
Name:AMMA HEALTH CARE CLINIC LLC
Entity Type:Organization
Organization Name:AMMA HEALTH CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNUS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-259-3778
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-0278
Mailing Address - Country:US
Mailing Address - Phone:256-259-3778
Mailing Address - Fax:256-259-3759
Practice Address - Street 1:302 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SECTION
Practice Address - State:AL
Practice Address - Zip Code:35771-7006
Practice Address - Country:US
Practice Address - Phone:256-259-3778
Practice Address - Fax:256-259-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22123261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center