Organization
MUHAMMAD EJAZ ATA
Active
Other names
Pisgah Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MUHAMMAD EJAZ ATA MD (MEDICAL DIRECTOR)
(256) 451-1250
Entity
Organization
Contact information
Practice address
6110 COUNTY ROAD 88, PISGAH MEDICAL CLINIC, PISGAH, AL 35765
(256) 451-1250
(256) 451-1270
Mailing address
PO BOX 246, 6110 COUNTY ROAD 88, PISGAH, AL 35765
(256) 451-1250
(256) 451-1270
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
00000
MD
208000000X
Pediatrics Physician
00000
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011432
BLUE CROSS
AL
05
—
541003864
—
AL
01
—
CM0511
RAILROAD MEDICACRE
—
Enumeration date
08/02/2006
Last updated
10/22/2009
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