Provider Demographics
NPI:1174668651
Name:DIGESTIVE DISEASE SPECIALISTS OF N.E. ALABAMA, P.C.
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE SPECIALISTS OF N.E. ALABAMA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYAPRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TUMMALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-492-3220
Mailing Address - Street 1:900 GOODYEAR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1107
Mailing Address - Country:US
Mailing Address - Phone:256-492-3220
Mailing Address - Fax:256-492-3759
Practice Address - Street 1:900 GOODYEAR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1107
Practice Address - Country:US
Practice Address - Phone:256-492-3220
Practice Address - Fax:256-492-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD643Medicare ID - Type Unspecified
ALK126Medicare ID - Type UnspecifiedANNISTON GI-AMIN
ALI240Medicare ID - Type UnspecifiedDR. AMIN GROUP