Provider Demographics
NPI:1598896938
Name:FAYETTE FAMILY MEDICINE, PSC
Entity Type:Organization
Organization Name:FAYETTE FAMILY MEDICINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-276-5566
Mailing Address - Street 1:1780 NICHOLASVILLE RD STE 604
Mailing Address - Street 2:BLDG B
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1440
Mailing Address - Country:US
Mailing Address - Phone:859-276-5566
Mailing Address - Fax:859-276-5562
Practice Address - Street 1:1780 NICHOLASVILLE RD STE 604
Practice Address - Street 2:BLDG B
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1440
Practice Address - Country:US
Practice Address - Phone:859-276-5566
Practice Address - Fax:859-276-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty