Provider Demographics
NPI:1811063399
Name:GENERAL PRACTICE M HAKIMA MD PC
Entity type:Organization
Organization Name:GENERAL PRACTICE M HAKIMA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-296-0136
Mailing Address - Street 1:PO BOX 1911
Mailing Address - Street 2:
Mailing Address - City:FLOMATON
Mailing Address - State:AL
Mailing Address - Zip Code:36441-1911
Mailing Address - Country:US
Mailing Address - Phone:251-296-0136
Mailing Address - Fax:251-296-1916
Practice Address - Street 1:1831 ROOSEVELT STREET
Practice Address - Street 2:PO DRAWER 1911
Practice Address - City:FLOMATON
Practice Address - State:AL
Practice Address - Zip Code:36441-1911
Practice Address - Country:US
Practice Address - Phone:251-296-0136
Practice Address - Fax:251-296-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1687649592OtherINDIVIDUAL NPI
AL=========OtherEMPLOYER IDENTIFICATION #
AL1687649592OtherINDIVIDUAL NPI