MEDICARE: FAULL S. TROVER, M.D.,P.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	2080P0006X	Developmental - Behavioral Pediatrics Physician	042750	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669443297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAULL S. TROVER, M.D.,P.C.

Provider Business Mailing Address
First Line	:	4155 BAKER ST NE
Second Line	:	SUITE 300
City	:	COVINGTON
State	:	GA
Zip	:	30014-1405
Country	:	US
Telephone Number	:	770-787-4122
Fax Number	:	770-787-4655

Provider Business Practice Location Address
First Line	:	4155 BAKER ST NE
Second Line	:	SUITE 300
City	:	COVINGTON
State	:	GA
Zip	:	30014-1405
Country	:	US
Telephone Number	:	770-787-4122
Fax Number	:	770-787-4655

Authorized Official
Title or Position	:	OWNER
Name	:	FAULL S TROVER
Credential	:	M.D.
Telephone Number	:	770-787-4122

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	08/22/2020

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