Healthcare Provider Details

I. General information

NPI: 1205715448
Provider Name (Legal Business Name): ERIC WILLIAM FAULKNER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E SOUTH BLVD
MONTGOMERY AL
36116-2409
US

IV. Provider business mailing address

4050 COUNTY HIGHWAY 1
ONEONTA AL
35121-3916
US

V. Phone/Fax

Practice location:
  • Phone: 256-673-7059
  • Fax:
Mailing address:
  • Phone: 256-673-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1-172872
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: