Provider Demographics
NPI:1508051350
Name:DR. PHOHA
Entity Type:Organization
Organization Name:DR. PHOHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ L.
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-331-7781
Mailing Address - Street 1:PO BOX 41027
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-7027
Mailing Address - Country:US
Mailing Address - Phone:205-331-7781
Mailing Address - Fax:205-758-8880
Practice Address - Street 1:1321 MCFARLAND BLVD E # 100
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-3839
Practice Address - Country:US
Practice Address - Phone:205-331-7781
Practice Address - Fax:205-758-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000893251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health