Provider Demographics
NPI:1639804313
Name:FUQUA PSYCHIATRIC CONSULTING, PLLC
Entity Type:Organization
Organization Name:FUQUA PSYCHIATRIC CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:FUQUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-201-2241
Mailing Address - Street 1:8000 W IH 10 STE 1500
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3883
Mailing Address - Country:US
Mailing Address - Phone:210-201-2241
Mailing Address - Fax:210-756-5125
Practice Address - Street 1:8000 W IH 10 STE 1500
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3883
Practice Address - Country:US
Practice Address - Phone:210-201-2241
Practice Address - Fax:210-756-5125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty