Healthcare Provider Details

I. General information

NPI: 1043315062
Provider Name (Legal Business Name): TIMOTHY FLEMING FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 MONTCLAIR RD
IRONDALE AL
35210-2263
US

IV. Provider business mailing address

1337 MONTCLAIR RD
IRONDALE AL
35210-2263
US

V. Phone/Fax

Practice location:
  • Phone: 205-203-8226
  • Fax: 205-203-8206
Mailing address:
  • Phone: 205-203-8226
  • Fax: 205-203-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-069618
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: