Healthcare Provider Details
I. General information
NPI: 1205858750
Provider Name (Legal Business Name): FELICIA M CARR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/24/2006
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
527 EISENHOWER DRIVE
SAVANNAH GA
31406-1612
US
IV. Provider business mailing address
602 E. 72ND STREET
SAVANNAH GA
31405-4913
US
V. Phone/Fax
- Phone: 912-819-9100
- Fax: 912-819-9101
- Phone: 912-819-7878
- Fax: 912-819-5044
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | 028190 |
| License Number State | GA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: