Provider Demographics
NPI:1215389341
Name:SAMUEL E FLEMING PHD & ASSOCIATES LLC
Entity Type:Organization
Organization Name:SAMUEL E FLEMING PHD & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:256-952-2819
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0428
Mailing Address - Country:US
Mailing Address - Phone:256-952-2819
Mailing Address - Fax:256-952-2824
Practice Address - Street 1:213 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4217
Practice Address - Country:US
Practice Address - Phone:256-952-2819
Practice Address - Fax:256-952-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1867103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL159493Medicaid