Healthcare Provider Details

I. General information

NPI: 1952575763
Provider Name (Legal Business Name): PIERRE RICHARD FEQUIERE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 17TH ST STE 106
COLUMBUS GA
31901
US

IV. Provider business mailing address

PO BOX 1038
COLUMBUS GA
31902-1038
US

V. Phone/Fax

Practice location:
  • Phone: 706-321-3760
  • Fax:
Mailing address:
  • Phone: 706-494-4300
  • Fax: 706-660-2847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number081263
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number081263
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: