Healthcare Provider Details

I. General information

NPI: 1356181457
Provider Name (Legal Business Name): MUHAMED FAOUR PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N MAIN ST
SHELBYVILLE TN
37160-2316
US

IV. Provider business mailing address

268 VETERANS PKWY
MURFREESBORO TN
37128-6431
US

V. Phone/Fax

Practice location:
  • Phone: 931-488-8895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6225
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: