MEDICARE: COURTNEY ERIN FAIRCHILD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9166	GA

General Provider Information

NPI Number	:	1477019925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ERIN FAIRCHILD PA-C

Provider Business Mailing Address
First Line	:	PO BOX 23329
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-3329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1248 AUGUSTA WEST PKWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1854
Country	:	US
Telephone Number	:	706-863-0500
Fax Number	:	706-855-5062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	04/06/2026

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