Provider Information for 1508316415
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MAURICE FAIRLEY Jr.
Sex: Male
NPI: 1508316415
Last Updated: 2021-12-16
Certification Date: 2021-12-16
Certification Date: 2021-12-16
Details
| Name | Value | ||||||||||||||
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| NPI | 1508316415 | ||||||||||||||
| Enumeration Date | 2016-10-04 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 5929 BRAMBLETON AVE RALEIGH, NC 27610-5597 United States Phone: 919-280-6550 | Fax: | ||||||||||||||
| Primary Practice Address | 500 BENSON RD GARNER, NC 27529-3947 United States Phone: 984-233-1471 | Fax:984-272-4865 | ||||||||||||||
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