Individual
JONATHAN FAUSETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
207 CARTER ST, BERRYVILLE, AR 72616-4303
(870) 423-3355
Mailing address
207 CARTER ST, BERRYVILLE, AR 72616-4303
(870) 423-3355
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-12113
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/20/2016
Last updated
06/04/2019
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