Individual
ANNA KATHERYN FAIRFAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
96 JONATHAN LUCAS ST, CHARLESTON, SC 29425-4607
(843) 792-7179
(843) 692-1122
Mailing address
96 JONATHAN LUCAS ST # 323, CHARLESTON, SC 29425-3230
(843) 792-7179
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
LL84375
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2020
Last updated
04/05/2023
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