Healthcare Provider Details

I. General information

NPI: 1629969753
Provider Name (Legal Business Name): ANDREW HAGGARD RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 GRANDVIEW PKWY
BIRMINGHAM AL
35243-3326
US

IV. Provider business mailing address

3056 WYNN WAY
OPELIKA AL
36804-7914
US

V. Phone/Fax

Practice location:
  • Phone: 334-296-0116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1-161602
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: