Provider Demographics
NPI:1699867770
Name:CAUSBEY, FAITH (NP)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:CAUSBEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794
Mailing Address - Country:US
Mailing Address - Phone:229-353-6208
Mailing Address - Fax:229-353-7722
Practice Address - Street 1:901 E 18TH ST
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
Practice Address - Country:US
Practice Address - Phone:229-353-6208
Practice Address - Fax:229-353-7722
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112129146N00000X
GARN112129363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112129OtherLICENSE NUMBER
GA000936438BMedicaid
GA50BBGDKMedicare ID - Type Unspecified
GA112129OtherLICENSE NUMBER