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Organization

MEDICAL SPA MOKSHA, L.L.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. WILLIAM B NICKELL M.D. (MEDICAL DIRECTOR)
(205) 980-9393
Entity
Organization

Contact information

Practice address
500 CAHABA PARK CIR, BIRMINGHAM, AL 35242-5087
(205) 980-9393
(205) 980-4494
Mailing address
500 CAHABA PARK CIR, BIRMINGHAM, AL 35242-5087
(205) 980-9393
(205) 980-4494

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
3370
AL
261QP2300X
Primary Care Clinic/Center
3370
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1306901517
NPI
Enumeration date
09/25/2009
Last updated
09/25/2009
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