Individual
GREGORY SHAWN FELZIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3 WEST ALTMAN STREET, STATESBORO, GA 30458-5212
(912) 764-2402
(912) 764-5561
Mailing address
3 WEST ALTMAN STREET, STATESBORO, GA 30458-5212
(912) 764-2402
(912) 764-5561
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23900
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152095001
—
AR
05
—
179537436E
—
GA
05
—
200015000A
—
OK
01
—
202I445780
PTAN
GA
Enumeration date
12/05/2005
Last updated
03/14/2012
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