Provider Demographics
NPI:1477839769
Name:NORTH ALABAMA REHABILITATION AND PAIN SPECIALIST LLC
Entity Type:Organization
Organization Name:NORTH ALABAMA REHABILITATION AND PAIN SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:OLUSEGUN
Authorized Official - Last Name:AWONIYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-604-0671
Mailing Address - Street 1:2046 BELTLINE RD SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-5549
Mailing Address - Country:US
Mailing Address - Phone:256-353-0410
Mailing Address - Fax:256-353-0649
Practice Address - Street 1:2046 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5549
Practice Address - Country:US
Practice Address - Phone:256-353-0410
Practice Address - Fax:256-353-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL302962081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty