Provider Demographics
NPI:1871085415
Name:ALABAMA SURGICAL ARTS, LLC
Entity type:Organization
Organization Name:ALABAMA SURGICAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:NIZAM
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:334-271-2002
Mailing Address - Street 1:4590 WOODMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2918
Mailing Address - Country:US
Mailing Address - Phone:334-271-2002
Mailing Address - Fax:
Practice Address - Street 1:4590 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2918
Practice Address - Country:US
Practice Address - Phone:334-271-4523
Practice Address - Fax:334-271-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty