Provider Demographics
NPI:1942529318
Name:E. LEE CHAMOUN
Entity type:Organization
Organization Name:E. LEE CHAMOUN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHAMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:205-631-0340
Mailing Address - Street 1:1603 DECATUR HWY
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2302
Mailing Address - Country:US
Mailing Address - Phone:205-631-0340
Mailing Address - Fax:205-631-0828
Practice Address - Street 1:1603 DECATUR HWY
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2302
Practice Address - Country:US
Practice Address - Phone:205-631-0340
Practice Address - Fax:205-631-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4498261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental