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General NPI Number Information
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NPI Number | 1255985016
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Entity Type | Individual
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Provider Name | DR. FARAHNAZ FAHIMIPOUR
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 1919 7TH AVE S RM 412
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City | BIRMINGHAM
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State | AL
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Zip | 35233-2005
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Country | US
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Telephone | 262-323-3556
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 7TH AVENUE SOUTH ROOM 412
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City | BIRMINGHAM
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State | AL
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Zip | 35294-0007
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Country | US
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Telephone | 262-323-3556
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 151257
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License Number State | NC
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