Organization
ANTHONY J FAVA, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY JOSEPH FAVA M.D. (OWNER)
(256) 832-4051
Entity
Organization
Contact information
Practice address
1425 GREENBRIER DEAR RD, ANNISTON, AL 36207-8706
(256) 832-4051
(256) 832-4092
Mailing address
1425 GREENBRIER DEAR RD, ANNISTON, AL 36207-8706
(256) 832-4051
(256) 832-4092
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
AL14852
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009918040
—
AL
Enumeration date
01/26/2011
Last updated
01/26/2011
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