Provider Demographics
NPI:1093359366
Name:FAISON MEDICAL CARE, PLLC
Entity Type:Organization
Organization Name:FAISON MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALPHONZA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:FNP
Authorized Official - Phone:336-622-6000
Mailing Address - Street 1:5201 W MARKET ST STE 108
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-3432
Mailing Address - Country:US
Mailing Address - Phone:336-622-6000
Mailing Address - Fax:
Practice Address - Street 1:5201 W MARKET ST STE 108
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-3432
Practice Address - Country:US
Practice Address - Phone:336-622-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1093359366Medicaid