Basic Information
| Provider Information | |||||||||
| NPI: | 1568026631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAUST | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ADAMS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CPSS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 817 BROWN ST | ||||||||
| Address2: | |||||||||
| City: | BISHOPVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290101178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038565080 | ||||||||
| FaxNumber: | 8034844299 | ||||||||
| Practice Location | |||||||||
| Address1: | 817 BROWN ST | ||||||||
| Address2: | |||||||||
| City: | BISHOPVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290101178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038565080 | ||||||||
| FaxNumber: | 8034844299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2019 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | 2019-898-01 | NC | Y |
No ID Information.