Healthcare Provider Details

I. General information

NPI: 1740212174
Provider Name (Legal Business Name): COASTAL NEUROLOGICAL INSTITUTE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 DAUPHIN ST SUITE A
MOBILE AL
36606-4060
US

IV. Provider business mailing address

3280 DAUPHIN ST SUITE A
MOBILE AL
36606-4060
US

V. Phone/Fax

Practice location:
  • Phone: 251-450-3700
  • Fax: 251-662-3819
Mailing address:
  • Phone: 251-450-3700
  • Fax: 251-662-3819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number16395
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20439
License Number StateAL

VIII. Authorized Official

Name: DR. WILLIAM B FAIRCLOTH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 251-450-3700