Provider Demographics
NPI:1801203369
Name:AZZAM MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:AZZAM MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/INTERNIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHANNAD
Authorized Official - Middle Name:FADL
Authorized Official - Last Name:AZZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-414-2936
Mailing Address - Street 1:101 1ST AVE NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-2967
Mailing Address - Country:US
Mailing Address - Phone:256-734-2977
Mailing Address - Fax:888-298-8524
Practice Address - Street 1:820 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6024
Practice Address - Country:US
Practice Address - Phone:205-425-5241
Practice Address - Fax:205-426-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty