Healthcare Provider Details

I. General information

NPI: 1578222535
Provider Name (Legal Business Name): AMBER FAIR BOOKER MS, RCEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ADAMS FARM LN STE 110
GREENSBORO NC
27407-7060
US

IV. Provider business mailing address

5112 AUTUMNCREST DR
GREENSBORO NC
27407-5801
US

V. Phone/Fax

Practice location:
  • Phone: 336-480-6310
  • Fax:
Mailing address:
  • Phone: 336-480-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number684655
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: