Healthcare Provider Details

I. General information

NPI: 1891769568
Provider Name (Legal Business Name): CAROLYN FELTUS-ATKINSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 5TH AVE
INDIALANTIC FL
32903-4273
US

IV. Provider business mailing address

325 5TH AVE STE 203
INDIALANTIC FL
32903-4270
US

V. Phone/Fax

Practice location:
  • Phone: 321-821-8449
  • Fax: 321-821-4890
Mailing address:
  • Phone: 321-821-4882
  • Fax: 321-821-4890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0054282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: