| Organization Name: | SHOALS MEDICAL GROUP, LLC |
| NPI Number: | 1891930491 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MOHAMMAD SIDDIQUE (DIRECTOR) |
| Mailing Address: | 1120 S Jackson Hwy Suite 301-b Sheffield |
| State: | AL US |
| Postal Code: | 356605777 |
| Phone Number: | 2563205405 |
| Fax Number: | 2563205407 |
| NPI Enumeration Date: | 12/10/2008 |
| NPI Last Update Date: | 04/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 22371 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |