Provider Demographics
NPI:1972992816
Name:FAGGINS, ALEXIA D
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:D
Last Name:FAGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXIA
Other - Middle Name:D
Other - Last Name:FAGGINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PARAPROFESSIONAL
Mailing Address - Street 1:2100 COMER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 COMER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8725
Practice Address - Country:US
Practice Address - Phone:706-596-5575
Practice Address - Fax:706-596-5589
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA320800000X320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness