Provider Demographics
NPI:1982688339
Name:FAULK, CLINTON E (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:E
Last Name:FAULK
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:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 E 10TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-8798
Practice Address - Country:US
Practice Address - Phone:252-847-4325
Practice Address - Fax:252-847-2034
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000401497208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900997Medicaid
NCP00245536OtherRAILROAD MEDICARE
NC139TUOtherBCBS NC
NCI32896Medicare UPIN
NC139TUOtherBCBS NC