Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 24699 | AL |
N | 207VG0400X | Gynecologist | 24689 | AL |
NPI | 1578586798 |
---|---|
Provider Name | Dr. George E Fahy III |
First Address | Bay Minette, AL 36507-4163 |
Second Address | Bay Minette, AL 36507-4163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 10/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009994760 | (05) | AL |
160059682 | RAILROAD RETIRE PROV NUMB (01) | |
51510969 | BCBS PROVIDER NUMBER (01) | AL |
630438739007 | CHAMPUS PROVIDER NUMBER (01) | |
G54479 | (02) |