MEDICARE: AUSTIN HUNTER FANN

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1578400214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN HUNTER FANN

Provider Business Mailing Address
First Line	:	1736 GREENSPOINT CT
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-8108
Country	:	US
Telephone Number	:	843-801-2467
Fax Number	:

Provider Business Practice Location Address
First Line	:	1736 GREENSPOINT CT
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-8108
Country	:	US
Telephone Number	:	843-801-2467
Fax Number	:

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

Provider Enumeration Date	:	04/30/2026
Last Update Date	:	04/30/2026

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