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Provider Information for 1740212174



COASTAL NEUROLOGICAL INSTITUTE P.C.

Organization Subpart: NO

Organization NPI: 1740212174

Calendar Last Updated: 2007-07-08

Details

Name Value
NPI 1740212174
Enumeration Date 2006-07-07
NPI Type 2- Organization
Status Active
Mailing Address 3280 DAUPHIN ST SUITE A
MOBILE, AL 36606-4060
United States

Phone: 251-450-3700 | Fax: 251-662-3819
View Map External Link
Primary Practice Address 3280 DAUPHIN ST SUITE A
MOBILE, AL 36606-4060
United States

Phone: 251-450-3700 | Fax: 251-662-3819
View Map External Link
Authorized Official Information Name: DR. WILLIAM B FAIRCLOTH M.D.
Title: PRESIDENT
Phone: 251-450-3700
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
No 193200000X MULTI-SPECIALTY GROUP
207T00000X - Neurological Surgery
AL 16395
No 193200000X MULTI-SPECIALTY GROUP
2081P2900X - Physical Medicine & Rehabilitation Pain Medicine
AL 20439
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location