Provider Demographics
NPI:1568026631
Name:FAUST, JOHN ADAMS (CPSS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ADAMS
Last Name:FAUST
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29010-1178
Mailing Address - Country:US
Mailing Address - Phone:803-856-5080
Mailing Address - Fax:803-484-4299
Practice Address - Street 1:817 BROWN ST
Practice Address - Street 2:
Practice Address - City:BISHOPVILLE
Practice Address - State:SC
Practice Address - Zip Code:29010-1178
Practice Address - Country:US
Practice Address - Phone:803-856-5080
Practice Address - Fax:803-484-4299
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-898-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist