Provider Demographics
NPI:1841212974
Name:AJAMOUGHLI, GHAITH (MD)
Entity Type:Individual
Prefix:DR
First Name:GHAITH
Middle Name:
Last Name:AJAMOUGHLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 GLENN BLVD SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-8413
Mailing Address - Country:US
Mailing Address - Phone:256-845-6900
Mailing Address - Fax:256-845-6911
Practice Address - Street 1:1040 GLENN BLVD SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-8413
Practice Address - Country:US
Practice Address - Phone:256-845-6900
Practice Address - Fax:256-845-6911
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51004641OtherBLUE CROSS
AL51558227OtherMEDICARE
AL009932321Medicaid
AL009932321Medicaid