Healthcare Provider Details

I. General information

NPI: 1396767893
Provider Name (Legal Business Name): MARY M FELDMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 DIXIE ST
CARROLLTON GA
30117-3922
US

IV. Provider business mailing address

410 DIXIE ST
CARROLLTON GA
30117-3922
US

V. Phone/Fax

Practice location:
  • Phone: 770-834-0818
  • Fax: 770-834-5098
Mailing address:
  • Phone: 504-231-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number69403
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number69403
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number69403
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: