Individual
DAVID FAIRCLOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9160 LAKESIDE WAY, GAINESVILLE, GA 30506-6224
(678) 777-3441
Mailing address
9160 LAKESIDE WAY, GAINESVILLE, GA 30506-6224
(678) 777-3441
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
06/15/2021
Last updated
06/15/2021
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