Provider Demographics
NPI:1447664339
Name:UAB FAMILY MEDICINE
Entity type:Organization
Organization Name:UAB FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PRASANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-701-1435
Mailing Address - Street 1:301 GOVERNORS DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5123
Mailing Address - Country:US
Mailing Address - Phone:256-551-4631
Mailing Address - Fax:
Practice Address - Street 1:301 GOVERNORS DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5123
Practice Address - Country:US
Practice Address - Phone:256-551-4631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL3441R261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center