Provider Demographics
NPI:1780647933
Name:FABER, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:FABER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 ROWLETT CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7082
Mailing Address - Country:US
Mailing Address - Phone:404-274-8801
Mailing Address - Fax:
Practice Address - Street 1:2101 W JOHN CARPENTER FWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3228
Practice Address - Country:US
Practice Address - Phone:469-759-4308
Practice Address - Fax:817-335-9100
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041782084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000739769CMedicaid
GA000739769AMedicaid
GA000739769DMedicaid
GA000739769CMedicaid
GA000739769AMedicaid