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General NPI Number Information
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NPI Number | 1376339895
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Entity Type | Individual
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Provider Name | PATRICK FAGAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2100 STANTONSBURG RD
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City | GREENVILLE
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State | NC
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Zip | 27834-2818
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Country | US
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Telephone | 770-733-2177
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Fax |
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Provider Business Mailing Address
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Address Line | 10 E FIELD ST
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City | NEWNAN
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State | GA
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Zip | 30263-2206
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Country | US
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Telephone | 770-733-2177
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | FAGA-I0ZYF7
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License Number State | NC
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