Healthcare Provider Details

I. General information

NPI: 1144135724
Provider Name (Legal Business Name): FAHREN BARTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SANCAR WAY
DURHAM NC
27713-2874
US

IV. Provider business mailing address

620 E 40TH ST
SAVANNAH GA
31401-9246
US

V. Phone/Fax

Practice location:
  • Phone: 919-371-2891
  • Fax:
Mailing address:
  • Phone: 912-665-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: