Individual
NICHOLAS FAULCONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
790 CHURCH ST NE STE 400, MARIETTA, GA 30060-8957
(770) 514-2776
Mailing address
PO BOX 3157, INDIANAPOLIS, IN 46206-3157
(770) 514-2776
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101265469
VA
2085R0202X
Diagnostic Radiology Physician
Primary
91733
GA
Other
Enumeration date
03/23/2016
Last updated
07/06/2022
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