1083599021 NPI number — DR. MADONNA ABDELMALAK GHOBRIAL OD

Table of content: DR. MADONNA ABDELMALAK GHOBRIAL OD (NPI 1083599021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083599021 NPI number — DR. MADONNA ABDELMALAK GHOBRIAL OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHOBRIAL
Provider First Name:
MADONNA
Provider Middle Name:
ABDELMALAK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083599021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 19TH ST N APT 715
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35203-3272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-430-2303
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1406 MCFARLAND BLVD N STE 1B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35406-2294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-556-2121
Provider Business Practice Location Address Fax Number:
205-831-8370
Provider Enumeration Date:
08/08/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  S-F71-TA-D60 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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