Healthcare Provider Details

I. General information

NPI: 1386320349
Provider Name (Legal Business Name): CATHERINE FAIRCLOTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HOSPITAL DR STE 330
MACON GA
31217-3895
US

IV. Provider business mailing address

7363 ZEBULON RD
MACON GA
31220
US

V. Phone/Fax

Practice location:
  • Phone: 478-200-8152
  • Fax:
Mailing address:
  • Phone: 478-973-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP292152
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberRN292152
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: