MEDICARE: SETH FAULKNER MS,AT

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	246R00000X	Pathology Technician

General Provider Information

NPI Number	:	1376995613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH FAULKNER MS,AT

Provider Business Mailing Address
First Line	:	1162 EDEN TER
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-3208
Country	:	US
Telephone Number	:	740-506-4358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1162 EDEN TER
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-3208
Country	:	US
Telephone Number	:	740-506-4358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	07/11/2016

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