Healthcare Provider Details

I. General information

NPI: 1811097462
Provider Name (Legal Business Name): FAZAL RAHIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 COGSWELL AVE
PELL CITY AL
35125-2702
US

IV. Provider business mailing address

4402 COGSWELL AVE
PELL CITY AL
35125-2702
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-9677
  • Fax: 256-362-9676
Mailing address:
  • Phone: 256-362-9677
  • Fax: 256-362-9676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25571
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: