Healthcare Provider Details

I. General information

NPI: 1316123821
Provider Name (Legal Business Name): RON FELDMAN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 CLIFTON RD NE FL 3
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

1525 CLIFTON RD NE FL 3
ATLANTA GA
30322-4200
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3333
  • Fax: 404-712-4920
Mailing address:
  • Phone: 404-778-3333
  • Fax: 404-712-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number066487
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: