Healthcare Provider Details

I. General information

NPI: 1073608626
Provider Name (Legal Business Name): WAYNE EVAN FLEISIG PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVENUE SOUTH ACC SUITE 500
BIRMINGHAM AL
35233
US

IV. Provider business mailing address

3709 CRESTBROOK ROAD
BIRMINGHAM AL
35223
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-9193
  • Fax:
Mailing address:
  • Phone: 205-969-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number715
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number715
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: