Healthcare Provider Details

I. General information

NPI: 1902487572
Provider Name (Legal Business Name): EMILY FELOUZIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 E FREEWAY DR SE
CONYERS GA
30094-5965
US

IV. Provider business mailing address

1190 GRIMES BRIDGE RD STE E
ROSWELL GA
30075-3955
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-7906
  • Fax:
Mailing address:
  • Phone: 770-992-7620
  • Fax: 770-992-8262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003448
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: