Healthcare Provider Details

I. General information

NPI: 1003885252
Provider Name (Legal Business Name): DAVID WILLIAM MACVICAR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LOOP RD
TUSCALOOSA AL
35404-5015
US

IV. Provider business mailing address

3701 LOOP RD
TUSCALOOSA AL
35404-5015
US

V. Phone/Fax

Practice location:
  • Phone: 205-554-2822
  • Fax:
Mailing address:
  • Phone: 205-554-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2902
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: