Shoals Medical Group, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

22371 Issued in AL

Legal business name

SHOALS MEDICAL GROUP, LLC

Practice address

1120 S Jackson Hwy
Suite 301-B
Sheffield, AL 35660-5777

Phone

(256) 320-5405

Fax

(256) 320-5407

NPI assigned

Dec 10, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mohammad Siddique, M.D.

Title

Director

Phone

(256) 320-5405

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271980800000",
    "number": "1891930491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S JACKSON HWY",
            "address_2": "SUITE 301-B",
            "city": "SHEFFIELD",
            "state": "AL",
            "postal_code": "356605777",
            "telephone_number": "256-320-5405",
            "fax_number": "256-320-5407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S JACKSON HWY",
            "address_2": "SUITE 301-B",
            "city": "SHEFFIELD",
            "state": "AL",
            "postal_code": "356605777",
            "telephone_number": "256-320-5405",
            "fax_number": "256-320-5407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOALS MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-10",
        "last_updated": "2010-04-23",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUE",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "256-320-5405",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "AL",
            "license": "22371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Beasley Shell, CRNP
• Christina Albright Sherer, CRNP
• Jon Alan Sherrod, MD
• Shoals Ear Nose & Throat Group PC
• Shoals Gastroenterology LLC
• Shoals Medical Trials, Inc.
• Shoals Pathology Services, LLC
• Shoals Primary Care, LLC
• Shoals Surgical Group LLC
• Shoals Urological Associates PC

• General Practice Physician in Sheffield, AL
• Providers in Sheffield, AL by specialty
• General Practice Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.