Healthcare Provider Details

I. General information

NPI: 1669313706
Provider Name (Legal Business Name): STEVAN CRAIG FAIRBURN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 UNIVERSITY BLVD
BIRMINGHAM AL
35233-1709
US

IV. Provider business mailing address

6 OLD NORTH RIVER PT
TUSCALOOSA AL
35406-1001
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-8884
  • Fax:
Mailing address:
  • Phone: 205-657-9913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: