Provider Demographics
NPI:1417521006
Name:FAHEY, JAMES GRANT (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GRANT
Last Name:FAHEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7797 PALMYRA DR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3442
Mailing Address - Country:US
Mailing Address - Phone:503-602-1329
Mailing Address - Fax:
Practice Address - Street 1:10423 OLD PLACERVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2540
Practice Address - Country:US
Practice Address - Phone:916-469-4690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty