Provider Information for 1255757951
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KALENE MCSWAIN FAULKNER
Sex: Female
NPI: 1255757951
Last Updated: 2018-03-28
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1255757951 | ||||||||
| Enumeration Date | 2014-03-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 35 PRESTON CT VILLA RICA, GA 30180-7359 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 35 PRESTON CT VILLA RICA, GA 30180-7359 United States Phone: 909-461-0047 | Fax: | ||||||||
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