MEDICARE: DR. GEORGE E FAHY III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	24689	AL
2	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	24699	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160059682	OTHER		RAILROAD RETIRE PROV NUMB
2	51510969	OTHER	AL	BCBS PROVIDER NUMBER
3	630438739007	OTHER		CHAMPUS PROVIDER NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578586798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE E FAHY III M.D.

Provider Business Mailing Address
First Line	:	2004 MEDICAL CENTER DR
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4163
Country	:	US
Telephone Number	:	251-937-2380
Fax Number	:	251-937-7841

Provider Business Practice Location Address
First Line	:	2004 MEDICAL CENTER DR
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4163
Country	:	US
Telephone Number	:	251-937-2380
Fax Number	:	251-937-7841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	06/10/2019

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