Provider Demographics
NPI:1376704635
Name:FAULK, LINDA ANN (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:FAULK
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 1:1018 DRUID PARK AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5848
Mailing Address - Country:US
Mailing Address - Phone:706-738-0455
Mailing Address - Fax:706-738-8588
Practice Address - Street 1:1018 DRUID PARK AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5848
Practice Address - Country:US
Practice Address - Phone:706-738-0455
Practice Address - Fax:706-738-8588
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67912208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice