Individual
RYAN TAYLOR FAIRCLOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3139 US HIGHWAY 19 NE, PELHAM, GA 31779-5391
(229) 319-5145
Mailing address
3139 US HIGHWAY 19 NE, PELHAM, GA 31779-5391
(229) 319-5145
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA004184
GA
Other
Enumeration date
03/13/2019
Last updated
03/13/2019
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