Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 19646 | MS |
NPI | 1699897066 |
---|---|
Provider Name | Dr. Carl Alvin Faulks |
First Address | Gulfport, MS 39507-3212 |
Second Address | Gulfport, MS 39507-3212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |