MEDICARE: FAITH MEDICAL CENTER P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1306582044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH MEDICAL CENTER P.C.

Provider Business Mailing Address
First Line	:	805 MONTAGUE AVE STE A
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-1464
Country	:	US
Telephone Number	:	864-223-6621
Fax Number	:	864-223-6659

Provider Business Practice Location Address
First Line	:	805 MONTAGUE AVE STE A
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29649-1464
Country	:	US
Telephone Number	:	864-223-6621
Fax Number	:	864-223-6659

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JOEL A ONAFOWOKAN
Credential	:	MD
Telephone Number	:	704-366-7182

Provider Enumeration Date	:	05/06/2022
Last Update Date	:	05/06/2022

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