Healthcare Provider Details

I. General information

NPI: 1164012027
Provider Name (Legal Business Name): NATHAN DAKOTA FARIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 WERRINGTON DR STE 200
HOLLY SPRINGS NC
27540-6018
US

IV. Provider business mailing address

4705 UNIVERSITY DR BLDG 700
DURHAM NC
27707-3489
US

V. Phone/Fax

Practice location:
  • Phone: 919-552-9952
  • Fax: 919-552-3062
Mailing address:
  • Phone: 919-237-1337
  • Fax: 866-538-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13395
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: