Organization
EAST ALABAMA NEUROLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISHNA KISHORE CHIVUKULA M.D. (PHYSICIAN)
(334) 887-0955
Entity
Organization
Contact information
Practice address
3120 FREDERICK RD, SUITE I, OPELIKA, AL 36801-7134
(334) 887-0955
(334) 887-0964
Mailing address
3120 FREDERICK RD STE I, OPELIKA, AL 36801-7135
(334) 887-0955
(334) 887-0964
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
3874
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
52906460
—
AL
Enumeration date
09/20/2007
Last updated
09/06/2013
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