Healthcare Provider Details

I. General information

NPI: 1861079519
Provider Name (Legal Business Name): FAGIN ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 03/27/2021
Certification Date: 03/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLONIAL CENTER PKWY STE 100N
ROSWELL GA
30076-4892
US

IV. Provider business mailing address

300 COLONIAL CENTER PKWY STE 100N
ROSWELL GA
30076-4892
US

V. Phone/Fax

Practice location:
  • Phone: 570-507-7553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONELL MARECHEAU
Title or Position: COMPLIANCE
Credential:
Phone: 570-507-7553