Provider Demographics
NPI:1336328533
Name:WEST ALABAMA PSYCHIATRIC ASSOCIATE
Entity Type:Organization
Organization Name:WEST ALABAMA PSYCHIATRIC ASSOCIATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:O
Authorized Official - Last Name:MOHABBAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-330-7700
Mailing Address - Street 1:4804 HIGHWAY 69 N
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-2035
Mailing Address - Country:US
Mailing Address - Phone:205-330-7700
Mailing Address - Fax:205-330-7718
Practice Address - Street 1:4804 HIGHWAY 69 N
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-2035
Practice Address - Country:US
Practice Address - Phone:205-330-7700
Practice Address - Fax:205-330-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL791051173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529923550Medicaid
ALJ979Medicare PIN