Basic Information
| Provider Information | |||||||||
| NPI: | 1811948615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AHMAD | ||||||||
| FirstName: | KAZI | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 CHEROKEE AVE S@ | ||||||||
| Address2: | |||||||||
| City: | CULLMAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567393500 | ||||||||
| FaxNumber: | 3567756119 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 CHEROKEE AVE SW | ||||||||
| Address2: | |||||||||
| City: | CULLMAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350555502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567393500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 00024328 | AL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 332100641 | 05 | AL | MEDICAID | 051557050 | 05 | AL | MEDICAID | 51557050 | 01 | AL | BCBS OF ALABAMA | OTHER | 1522606 | 01 | AL | UBH - BASIC SERVICES | OTHER | 51537567 | 01 | AL | BCBS | OTHER | 009940374 | 05 | AL | MEDICAID | 1532606 | 01 | AL | UBH - PLUS SERVICES | OTHER |