Healthcare Provider Details

I. General information

NPI: 1881008902
Provider Name (Legal Business Name): RONALD FAUDREE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 CANAL STREET, UNIT 308 SC HOUSE CALLS INC/GA HOUSE CALLS INC
POOLER GA
31322
US

IV. Provider business mailing address

1053 CENTER STREET SC HOUSE CALLS INC
WEST COLUMBIA SC
29169
US

V. Phone/Fax

Practice location:
  • Phone: 800-491-0909
  • Fax:
Mailing address:
  • Phone: 800-491-0909
  • Fax: 912-644-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN212187
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: