Provider Demographics
NPI:1508281270
Name:FAIRCLOUGH, JAUN PAUL
Entity Type:Individual
Prefix:
First Name:JAUN
Middle Name:PAUL
Last Name:FAIRCLOUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3852 MIRANDA CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8670
Mailing Address - Country:US
Mailing Address - Phone:770-608-7317
Mailing Address - Fax:770-212-3714
Practice Address - Street 1:3852 MIRANDA CT
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8670
Practice Address - Country:US
Practice Address - Phone:770-608-7317
Practice Address - Fax:770-212-3714
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst