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Individual
THEODORE STEVENS FEELY
Active
Individual
THEODORE STEVENS FEELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
060832
GA
207R00000X
Internal Medicine Physician
200500182
NC
207RN0300X
Nephrology Physician
060832
GA
207RN0300X
Nephrology Physician
Primary
34508
AL
208M00000X
Hospitalist Physician
MD.34508
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1241808
AMERIGROUP
GA
05
—
196561329A
—
GA
01
—
52260873 001
BCBS - GA
GA
01
—
N460702
WELLCARE
GA
01
—
P00649787
MEDICARE - RAILROAD
GA
Enumeration date
01/17/2007
Last updated
11/20/2018
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