Healthcare Provider Details

I. General information

NPI: 1649477407
Provider Name (Legal Business Name): WILLIAM MATTHEW FALLIN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MEDICAL STREET
SNEAD AL
35952
US

IV. Provider business mailing address

180 MEDICAL ST
SNEAD AL
35952-6468
US

V. Phone/Fax

Practice location:
  • Phone: 205-466-7114
  • Fax: 205-466-3350
Mailing address:
  • Phone: 205-466-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-527
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: