Healthcare Provider Details

I. General information

NPI: 1730712571
Provider Name (Legal Business Name): EMILY FALLON HUMPHREYS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 GRANDVIEW PKWY STE 530
BIRMINGHAM AL
35243-3405
US

IV. Provider business mailing address

38 W MONTCREST DR
MOUNTAIN BRK AL
35213-3024
US

V. Phone/Fax

Practice location:
  • Phone: 205-591-8260
  • Fax:
Mailing address:
  • Phone: 205-332-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1582
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: