1275291676 NPI number — DR. ERICA ANN FAWLEY PHARMD

Table of content: DR. ERICA ANN FAWLEY PHARMD (NPI 1275291676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275291676 NPI number — DR. ERICA ANN FAWLEY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAWLEY
Provider First Name:
ERICA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275291676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2081 CALLAWAY PARK PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THOMPSONS STATION
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37179-5407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9100 CAROTHERS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-771-6760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  21885 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)