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General NPI Number Information
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NPI Number | 1598896938
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Entity Type | Organization
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Legal Business Name | FAYETTE FAMILY MEDICINE, PSC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1780 NICHOLASVILLE RD STE 604 BLDG B
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City | LEXINGTON
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State | KY
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Zip | 40503-1440
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Country | US
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Telephone | 859-276-5566
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Fax | 859-276-5562
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Provider Business Mailing Address
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Address Line | 1780 NICHOLASVILLE RD STE 604 BLDG B
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City | LEXINGTON
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State | KY
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Zip | 40503-1440
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Country | US
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Telephone | 859-276-5566
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Fax | 859-276-5562
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREA SKAGGS
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Credential | M.D.
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Telephone | 859-276-5566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34084
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License Number State | KY
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