Individual
JOHN ELLIOTT FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 GOVERNORS DR SW, HUNTSVILLE, AL 35801-5123
(256) 536-5511
Mailing address
301 GOVERNORS DR SW, HUNTSVILLE, AL 35801-5123
(256) 536-5511
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22224
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000007557
—
AL
01
—
0004265233
AETNA IDENTIFICATION NO
—
05
—
051558693
—
AL
01
—
51007557
BLUE CROSS BLUE SHIELD
AL
01
—
621491901
TAX IDENTIFICATION NO
—
Enumeration date
11/11/2005
Last updated
06/13/2024
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