Organization
VALLEY HEAD CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUHAMMAD EJAZ ATA M.D (OWNER)
(256) 451-1250
Entity
Organization
Contact information
Practice address
205 GRAND AVE NW, STE B, FORT PAYNE, AL 35967-2107
(256) 979-1515
(256) 979-1517
Mailing address
205 GRAND AVE NW, STE B, FORT PAYNE, AL 35967-2107
(256) 979-1515
(256) 979-1517
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
16386
AL
Other
Enumeration date
05/28/2010
Last updated
03/28/2017
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