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General NPI Number Information
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NPI Number | 1306142161
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Entity Type | Organization
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Legal Business Name | ANTHONY J FAVA, MD PC
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 1425 GREENBRIER DEAR RD
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City | ANNISTON
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State | AL
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Zip | 36207-8706
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Country | US
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Telephone | 256-832-4051
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Fax | 256-832-4092
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Provider Business Mailing Address
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Address Line | 1425 GREENBRIER DEAR RD
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City | ANNISTON
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State | AL
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Zip | 36207-8706
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Country | US
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Telephone | 256-832-4051
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Fax | 256-832-4092
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY JOSEPH FAVA
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Credential | M.D.
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Telephone | 256-832-4051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AL14852
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License Number State | AL
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