Provider Demographics
NPI:1104617281
Name:FAULKNOR, ANNA REESE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:REESE
Last Name:FAULKNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 HO HUM HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-5534
Mailing Address - Country:US
Mailing Address - Phone:678-763-0777
Mailing Address - Fax:
Practice Address - Street 1:1711 MERIWEATHER DR STE 100
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7789
Practice Address - Country:US
Practice Address - Phone:706-431-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty