Provider Demographics
NPI:1043522352
Name:FAUGHT, RACHAEL W (DO)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:W
Last Name:FAUGHT
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DEPARTMENT OF MEDICINE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5601
Mailing Address - Fax:601-984-6665
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5601
Practice Address - Fax:601-984-6665
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MST-2308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST-2308OtherMS TEMPORARY MEDICAL LICENSE