Healthcare Provider Details

I. General information

NPI: 1740210822
Provider Name (Legal Business Name): WADE FAULKNER, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 DAUPHIN ST SUITE 401
MOBILE AL
36606-4062
US

IV. Provider business mailing address

250 STATE FARM PKWY
BIRMINGHAM AL
35209-7181
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-3309
  • Fax: 251-471-5046
Mailing address:
  • Phone: 205-943-4650
  • Fax: 205-943-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: HENRY WADE FAULKNER
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 251-471-3309