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General NPI Number Information
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NPI Number | 1558552638
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Entity Type | Organization
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Legal Business Name | FAY FERRELL, M.D., PH.D., LLC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 114 E TROY ST
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City | DOTHAN
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State | AL
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Zip | 36303-4844
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Country | US
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Telephone | 334-671-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 114 E TROY ST
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City | DOTHAN
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State | AL
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Zip | 36303-4844
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Country | US
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Telephone | 334-671-5577
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MADELINE FAY FERRELL
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Credential | M.D., PH.D.
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Telephone | 334-671-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 19045
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License Number State | AL
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