Provider Demographics
NPI:1730340191
Name:MACFALL, TIMOTHY ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALLAN
Last Name:MACFALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FRANKLIN ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:256-539-5827
Practice Address - Street 1:2006 FRANKLIN ST SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:256-539-5827
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN654642085R0202X
AL439742085R0202X
SC310322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL280058Medicaid
AL279959Medicaid
AL280230Medicaid
AL280459Medicaid
AL280583Medicaid
AL280596Medicaid
AL280395Medicaid
AL280420Medicaid
CO280585Medicaid
AL280599Medicaid
TNQ073133Medicaid