Provider Demographics
NPI:1023199817
Name:FAISON, VANOSIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:VANOSIA
Middle Name:S
Last Name:FAISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MEDICAL CENTER DR STE F
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7286
Mailing Address - Country:US
Mailing Address - Phone:334-568-2335
Mailing Address - Fax:334-380-3567
Practice Address - Street 1:102 MEDICAL CENTER DR STE F
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7286
Practice Address - Country:US
Practice Address - Phone:334-568-2335
Practice Address - Fax:334-380-3567
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30745208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2070375Medicare PIN