David Formwalt, Psy.D., LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1104 Issued in AL

Legal business name

DAVID FORMWALT, PSY.D., LLC

Practice address

7305 Cottage Hill Rd
Mobile, AL 36695-2829

Phone

(251) 776-1217

Fax

(251) 776-1219

NPI assigned

May 5, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David J Formwalt, PSY.D.NPI 1164591541

Title

Clinical Psychologist

Phone

(251) 776-1217

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Formwalt, PSY D

  • Clinical Psychologist
  • Mobile, AL
  • NPI 1164591541
  Medicare reassignment Authorized official
• Annie L Formwalt, PSY.D.

  • Clinical Psychologist
  • Mobile, AL
  • NPI 1861696759
  NPD (past)
• Lucile T Williams, PSY.D.

  • Clinical Psychologist
  • Mobile, AL
  • NPI 1558565440
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1316113970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 91276",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366911276",
            "telephone_number": "251-776-1217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7305 COTTAGE HILL RD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366952829",
            "telephone_number": "251-776-1217",
            "fax_number": "251-776-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID FORMWALT, PSY.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-05",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "FORMWALT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "251-776-1217",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "AL",
            "license": "1104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manuel Preston Daugherty, MD
• Sarrah Ann Daugherty, DMD
• Cody Daum, MD
• Kent M Daum, O.D.
• Dauphin Optical
• David J Borcicky PC
• David Shane Welch DMD PC
• Anna Maria Davidson, PA
• Ashley Marie Davidson, MA, LBA, BCBA
• Josie Davidson, ALC, NCC

• Psychologist in Mobile, AL
• Providers in Mobile, AL by specialty
• Psychologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.