Individual
FEODERIS N BASILIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
104 14TH ST, COLUMBUS, GA 31901-2131
(706) 507-5437
(706) 507-5499
Mailing address
104 14TH ST, COLUMBUS, GA 31901-2131
(706) 507-5437
(706) 507-5499
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
050092
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000958702A
PEACH STATE HEALTH PLAN
GA
05
—
000958702A
—
GA
01
—
306085
WELLCARE
GA
01
—
52009279
BCBS GA
GA
01
—
60103339
BCBS AL
AL
Enumeration date
02/23/2007
Last updated
06/30/2011
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