Healthcare Provider Details

I. General information

NPI: 1437716560
Provider Name (Legal Business Name): JOHN FALLIGANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 EXECUTIVE PARK DR
OPELIKA AL
36801-6042
US

IV. Provider business mailing address

751 N CARY DR
AUBURN AL
36830-2528
US

V. Phone/Fax

Practice location:
  • Phone: 205-807-2371
  • Fax:
Mailing address:
  • Phone: 205-807-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2432
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: