=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073707907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FITE & NEWLIN, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2007
-----------------------------------------------------
Last Update Date | 09/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11100 S MEMORIAL PKWY
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35803-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-650-4665
-----------------------------------------------------
Fax | 256-650-4624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11100 S MEMORIAL PKWY
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35803-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-650-4665
-----------------------------------------------------
Fax | 256-650-4624
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DAWN VAUGHN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-650-4665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 7892
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | DO645
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------