Provider Demographics
NPI:1730478934
Name:ALABAMA DEVELOPMENTAL CLINIC, LLC
Entity type:Organization
Organization Name:ALABAMA DEVELOPMENTAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-554-0866
Mailing Address - Street 1:661 HELEN KELLER BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2963
Mailing Address - Country:US
Mailing Address - Phone:205-554-0866
Mailing Address - Fax:205-554-0279
Practice Address - Street 1:661 HELEN KELLER BLVD
Practice Address - Street 2:STE A
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2963
Practice Address - Country:US
Practice Address - Phone:205-554-0866
Practice Address - Fax:205-554-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22316174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty