Healthcare Provider Details

I. General information

NPI: 1215391560
Provider Name (Legal Business Name): TIMOTHY MAEEN SAHAWNEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 WHITESBURG DR SW STE 200
HUNTSVILLE AL
35802-1681
US

IV. Provider business mailing address

4704 WHITESBURG DR SW STE 200
HUNTSVILLE AL
35802-1681
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-4510
  • Fax: 256-880-4512
Mailing address:
  • Phone: 256-880-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.42550
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: