Healthcare Provider Details

I. General information

NPI: 1205489200
Provider Name (Legal Business Name): DEBORAH E. FAULKNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11578 HIGHWAY 27
SUMMERVILLE GA
30747-5873
US

IV. Provider business mailing address

PO BOX 1027
LA FAYETTE GA
30728-1027
US

V. Phone/Fax

Practice location:
  • Phone: 706-857-5441
  • Fax: 888-857-9969
Mailing address:
  • Phone: 423-598-8465
  • Fax: 706-639-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN041450
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: