Healthcare Provider Details

I. General information

NPI: 1366479321
Provider Name (Legal Business Name): OSCAR R FEBLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HIGHLAND CT SUITE 201
EAST ELLIJAY GA
30540-6772
US

IV. Provider business mailing address

PO BOX 1019
ELLIJAY GA
30540-0013
US

V. Phone/Fax

Practice location:
  • Phone: 706-697-5437
  • Fax: 706-697-6437
Mailing address:
  • Phone: 706-697-5437
  • Fax: 706-697-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number038482
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: