Provider Demographics
NPI:1336289289
Name:NEUROLOGY CONSULTANTS OF CENTRAL ALABAMA
Entity Type:Organization
Organization Name:NEUROLOGY CONSULTANTS OF CENTRAL ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALID
Authorized Official - Middle Name:WAJIH
Authorized Official - Last Name:FREIJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-872-8627
Mailing Address - Street 1:217 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-4589
Mailing Address - Country:US
Mailing Address - Phone:334-872-8627
Mailing Address - Fax:334-872-8629
Practice Address - Street 1:217 BROAD ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4589
Practice Address - Country:US
Practice Address - Phone:334-872-8627
Practice Address - Fax:334-872-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18755174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529702780Medicaid