Individual
MATTHEW CLARK FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
1401 GREENSBORO AVE, TUSCALOOSA, AL 35401-2842
(205) 391-4000
Mailing address
3709 DIAMOND LN, NORTHPORT, AL 35473-2642
(205) 792-4167
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1-105627
AL
Other
Enumeration date
05/26/2025
Last updated
05/26/2025
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