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General NPI Number Information
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NPI Number | 1912537119
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Entity Type | Organization
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Legal Business Name | FAIRFIELD MEDICAL ASSOCIATES, PA
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 428 MCNULTY ST STE 3
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-8786
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Country | US
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Telephone | 803-754-8941
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Fax | 803-635-4200
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Provider Business Mailing Address
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Address Line | PO BOX 1218
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City | WINNSBORO
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State | SC
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Zip | 29180-5218
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Country | US
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Telephone | 803-815-5568
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Fax | 803-635-4200
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ELIZABETH MANN
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Credential |
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Telephone | 803-635-6461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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