Healthcare Provider Details

I. General information

NPI: 1396807780
Provider Name (Legal Business Name): FAULK MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S JEFFERSON AVE
EATONTON GA
31024-1129
US

IV. Provider business mailing address

303 S JEFFERSON AVE
EATONTON GA
31024-1129
US

V. Phone/Fax

Practice location:
  • Phone: 706-485-6262
  • Fax:
Mailing address:
  • Phone: 706-485-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number005813
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number005813
License Number StateGA

VIII. Authorized Official

Name: BRUCE MICHAEL FAULK
Title or Position: PRESIDENT
Credential:
Phone: 706-485-6262