Provider Demographics
NPI:1619379047
Name:FAULDS, CHARLES GUILLERMO
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:GUILLERMO
Last Name:FAULDS
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 1:62 SKYLAND SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31315-1791
Mailing Address - Country:US
Mailing Address - Phone:470-262-0912
Mailing Address - Fax:
Practice Address - Street 1:62 SKYLAND SPRUCE DR
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31315-1791
Practice Address - Country:US
Practice Address - Phone:470-262-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist