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General NPI Number Information
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NPI Number | 1275984916
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Entity Type | Organization
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Legal Business Name | JOHN E FANNING,MD,INC
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 420 LOWELL DR SE SUITE 105
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3754
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Country | US
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Telephone | 256-535-5970
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Fax |
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Provider Business Mailing Address
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Address Line | 420 LOWELL DR SE STE 103
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3754
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN E FANNING
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Credential | MD
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Telephone | 256-535-5940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 22224
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License Number State | AL
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