Provider Demographics
NPI:1447681762
Name:THE ENDOCRINE, DIABETES AND METABOLISM CLINIC P.C
Entity type:Organization
Organization Name:THE ENDOCRINE, DIABETES AND METABOLISM CLINIC P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:YASMEEN
Authorized Official - Last Name:GHORI-JAVED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-802-8474
Mailing Address - Street 1:3918 MONTCLAIR ROAD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213
Mailing Address - Country:US
Mailing Address - Phone:205-802-8474
Mailing Address - Fax:205-802-8753
Practice Address - Street 1:3918 MONTCLAIR ROAD
Practice Address - Street 2:SUITE 217
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213
Practice Address - Country:US
Practice Address - Phone:205-802-8474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD27794261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH27660Medicare UPIN