Healthcare Provider Details

I. General information

NPI: 1306998687
Provider Name (Legal Business Name): FIG TREE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 GREENVILLE HWY
LYMAN SC
29365-1515
US

IV. Provider business mailing address

12315 GREENVILLE HWY PO BOX 699
LYMAN SC
29365-1515
US

V. Phone/Fax

Practice location:
  • Phone: 864-439-4376
  • Fax: 864-439-4385
Mailing address:
  • Phone: 864-439-4376
  • Fax: 864-439-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number00940
License Number StateSC

VIII. Authorized Official

Name: DR. MANUEL FACHADO JR.
Title or Position: CEO
Credential: DO
Phone: 864-439-4376