Healthcare Provider Details

I. General information

NPI: 1861586034
Provider Name (Legal Business Name): WALID WAJIH FREIJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 BROAD ST
SELMA AL
36701-4589
US

IV. Provider business mailing address

217 BROAD ST
SELMA AL
36701-4589
US

V. Phone/Fax

Practice location:
  • Phone: 334-872-8627
  • Fax: 334-872-8629
Mailing address:
  • Phone: 334-872-8627
  • Fax: 334-872-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number18755
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: