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General NPI Number Information
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NPI Number | 1104311620
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Entity Type | Individual
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Provider Name | CAMERYN FAULKNER
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Gender | Female
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 5140 JIMMY LEE SMITH PKWY
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City | HIRAM
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State | GA
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Zip | 30141-2745
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Country | US
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Telephone | 770-439-1038
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Fax | 504-364-8968
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Provider Business Mailing Address
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Address Line | 5140 JIMMY LEE SMITH PKWY STE 101
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City | HIRAM
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State | GA
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Zip | 30141-2746
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123574
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License Number State | GA
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