Provider Demographics
NPI:1083645584
Name:FAIRVIEW FAMILY PRACTICE
Entity Type:Organization
Organization Name:FAIRVIEW FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACKESSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-967-4982
Mailing Address - Street 1:103 FAIRVIEW POINTE DR.
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681
Mailing Address - Country:US
Mailing Address - Phone:864-967-4982
Mailing Address - Fax:864-967-8465
Practice Address - Street 1:103 FAIRVIEW POINTE DR.
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681
Practice Address - Country:US
Practice Address - Phone:864-967-4982
Practice Address - Fax:864-967-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty