Individual
DR. GHAITH AJAMOUGHLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1040 GLENN BLVD SW, FORT PAYNE, AL 35967-8413
(256) 845-6900
(256) 845-6911
Mailing address
1040 GLENN BLVD SW, FORT PAYNE, AL 35967-8413
(256) 845-6900
(256) 845-6911
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00019459
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009932321
—
AL
01
—
51004641
BLUE CROSS
AL
01
—
51558227
MEDICARE
AL
Enumeration date
07/25/2006
Last updated
01/06/2016
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