Provider Demographics
NPI:1134489248
Name:FAITH HEALTH SERVICES INC
Entity Type:Organization
Organization Name:FAITH HEALTH SERVICES INC
Other - Org Name:CPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKERIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-598-8031
Mailing Address - Street 1:240 PROSPECT PL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5454
Mailing Address - Country:US
Mailing Address - Phone:678-624-1646
Mailing Address - Fax:770-442-3320
Practice Address - Street 1:3100 MEDLOCK BRIDGE RD STE 500
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1441
Practice Address - Country:US
Practice Address - Phone:770-442-8928
Practice Address - Fax:770-442-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1162483OtherNCPDP PROVIDER IDENTIFICATION NUMBER