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General NPI Number Information
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NPI Number | 1114091469
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Entity Type | Individual
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Provider Name | KANEY JERVELLE FEDOVSKIY M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 80 JESSE HILL JR DR SE #26024
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City | ATLANTA
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State | GA
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Zip | 30303-3031
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Country | US
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Telephone | 404-616-6689
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Fax | 404-616-0207
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Provider Business Mailing Address
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Address Line | 170 BOULEVARD SE APT #E122
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City | ATLANTA
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State | GA
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Zip | 30312-2325
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Country | US
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Telephone | 404-441-0477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 054710
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A97005
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License Number State | CA
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