Provider Demographics
NPI:1790970499
Name:FLORENCE ALABAMA NEUROLOGY CLINIC, INC
Entity Type:Organization
Organization Name:FLORENCE ALABAMA NEUROLOGY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:BADR
Authorized Official - Last Name:SULTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-764-8900
Mailing Address - Street 1:2407 HELTON DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1067
Mailing Address - Country:US
Mailing Address - Phone:256-764-8900
Mailing Address - Fax:256-764-6666
Practice Address - Street 1:2407 HELTON DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1067
Practice Address - Country:US
Practice Address - Phone:256-764-8900
Practice Address - Fax:256-764-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL281822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty