Provider Demographics
NPI:1710195524
Name:FAUQUET, COURTNEY ADRIENNE (MS, ATC, NREMT-B)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:ADRIENNE
Last Name:FAUQUET
Suffix:
Gender:F
Credentials:MS, ATC, NREMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 RIVER CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1684
Mailing Address - Country:US
Mailing Address - Phone:678-481-7399
Mailing Address - Fax:
Practice Address - Street 1:2244 RIVER CLIFF DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1684
Practice Address - Country:US
Practice Address - Phone:678-481-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0011942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer