Healthcare Provider Details

I. General information

NPI: 1255874202
Provider Name (Legal Business Name): JOHN FAWCETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 GEIGER BOULEVARD BUILDING 598, MCAS BEAUFORT
BEAUFORT SC
29906
US

IV. Provider business mailing address

598 GEIGER BOULEVARD BUILDING 598, MCAS BEAUFORT
BEAUFORT SC
29906
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-7530
  • Fax:
Mailing address:
  • Phone: 843-228-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9191
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: