Faircloth, Johnnie Wayne

Faircloth, Johnnie Wayne is an individual health care provider with primary practice located at 1400 S Coulter St , Amarillo TX 79106-1786. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Faircloth, Johnnie Wayne can be contacted via phone (806) 414-9800.

Contact Information

Primary practice address
1400 S Coulter St Amarillo TX 79106-1786
Phone: (806) 414-9800
Fax: (806) 354-5689
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X N7537 Texas
Allopathic & Osteopathic Physicians / Sports Medicine 2080S0010X N7537 Texas

Profile Details

NPI number 1912168600
LBN Legal business name Faircloth, Johnnie Wayne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 24th, 2008
Last updated Jul 18th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912168600 NPPES
Texas MEDICAID 280457704
Texas MEDICAID 280457702
Texas MEDICAID 200340500 A
Texas MEDICAID 67474560

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