Healthcare Provider Details

I. General information

NPI: 1497818579
Provider Name (Legal Business Name): GEORGE DAVID FAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MARKS RD
OCEAN SPRINGS MS
39564-4351
US

IV. Provider business mailing address

22 DOCTORS DR
OCEAN SPRINGS MS
39564
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-0563
  • Fax: 228-818-0519
Mailing address:
  • Phone: 228-818-0563
  • Fax: 228-818-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number09296
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: