Individual
WILLIAM JOSEPH FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
240 HOSPITAL DR NE, BOLIVIA, NC 28422-8346
(910) 755-1004
(910) 755-1474
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(910) 755-1004
(910) 755-1474
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
9500344
NC
208M00000X
Hospitalist Physician
Primary
9500344
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890282V
—
NC
05
—
891117J
—
NC
05
—
N00346
—
SC
Enumeration date
02/12/2007
Last updated
10/25/2020
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