Individual
JOHN O. FAIREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1301 TAYLOR ST, SUITE 1A, COLUMBIA, SC 29201-2942
(803) 254-4591
(803) 931-8000
Mailing address
1301 TAYLOR ST, SUITE 1A, COLUMBIA, SC 29201-2942
(803) 254-4591
(803) 931-8000
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
11357
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113576
—
SC
Enumeration date
07/27/2006
Last updated
12/03/2007
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