Healthcare Provider Details

I. General information

NPI: 1639275910
Provider Name (Legal Business Name): RAY J. FLYNN DSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SOUTHLAND DR SUITE 218
BIRMINGHAM AL
35226-3710
US

IV. Provider business mailing address

2253 FARLEY RD
BIRMINGHAM AL
35226-1071
US

V. Phone/Fax

Practice location:
  • Phone: 205-979-8633
  • Fax:
Mailing address:
  • Phone: 205-979-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-0499C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: