Healthcare Provider Details

I. General information

NPI: 1356073886
Provider Name (Legal Business Name): UAB FAMILY AND COMMUNITY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 EMERY DR W
HOOVER AL
35244-4625
US

IV. Provider business mailing address

4749 RED LEAF CIR
HOOVER AL
35226-4213
US

V. Phone/Fax

Practice location:
  • Phone: 205-989-7254
  • Fax:
Mailing address:
  • Phone: 205-704-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA FAUGHT
Title or Position: REGISTERED DIETITIAN
Credential: RDN
Phone: 205-704-7800