# FAWAZ MEDICAL AND SURGICAL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801207626
- **Authorized official:** JANNA MAULDIN (OFFICE MANAGER)
- **Authorized official phone:** (850) 951-8800

## Contact information

- **Practice address:** 962 US HIGHWAY 331 S, DEFUNIAK SPRINGS, FL 32435-3372
- **Practice address phone:** (850) 951-8800
- **Mailing address:** 962 US HIGHWAY 331 S, DEFUNIAK SPRINGS, FL 32435-3372
- **Mailing address phone:** (850) 951-8800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | ME82523 | ZZ | Yes |

## Other

- **Enumeration date:** 05/14/2014
- **Last updated:** 05/14/2014