Provider Demographics
NPI:1669555769
Name:FAISON-ALSTON, GENEVIEVE SANATRA (MD)
Entity type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:SANATRA
Last Name:FAISON-ALSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 DURHAM RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8793
Mailing Address - Country:US
Mailing Address - Phone:919-435-1099
Mailing Address - Fax:
Practice Address - Street 1:853 DURHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8793
Practice Address - Country:US
Practice Address - Phone:919-435-1099
Practice Address - Fax:919-435-1130
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901171208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
331532OtherWELL PATH
NC8912588Medicaid
1258XOtherBLUE CROSS BLUE SHIELD
2409370OtherCIGNA
229108OtherUNITED HEALTH CARE
NC8912588Medicaid