Healthcare Provider Details

I. General information

NPI: 1063592525
Provider Name (Legal Business Name): JERRY ANDREW FIKES DMD MAGD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 MCFARLAND CIRCLE NORTH
TUSCALOOSA AL
35406
US

IV. Provider business mailing address

217 MCFARLAND CIRCLE NORTH
TUSCALOOSA AL
35406
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-7755
  • Fax: 205-343-9075
Mailing address:
  • Phone: 205-345-7755
  • Fax: 205-343-9075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3162
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: