=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720113897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN WADE FAUGHT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3702 2ND AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-7408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-507-9249
-----------------------------------------------------
Fax | 706-507-9249
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 N LAKE DR
-----------------------------------------------------
City | CATAULA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31804-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-649-8141
-----------------------------------------------------
Fax | 706-544-3234
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 043041
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------