Healthcare Provider Details

I. General information

NPI: 1487703245
Provider Name (Legal Business Name): DR. FELIPE REYES MUSNGI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 JEFFERSON STREET
STATHAM GA
30666
US

IV. Provider business mailing address

337 JEFFERSON STREET
STATHAM GA
30666
US

V. Phone/Fax

Practice location:
  • Phone: 770-725-7994
  • Fax: 770-725-7994
Mailing address:
  • Phone: 770-725-7994
  • Fax: 770-725-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number023195
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: