Individual
DR. AMELIA C FAIRFAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2270 ASHLEY CROSSING DR STE 150, CHARLESTON, SC 29414-5702
(843) 766-1936
(843) 766-1206
Mailing address
PO BOX 13955, CHARLESTON, SC 29422-3955
(843) 766-1936
(843) 766-1206
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22266
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
222666
—
SC
Enumeration date
11/06/2006
Last updated
10/10/2017
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