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General NPI Number Information
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NPI Number | 1154413961
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Entity Type | Individual
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Provider Name | PATRICE MICKI FEDDES
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 911 E 65TH ST
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City | SAVANNAH
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State | GA
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Zip | 31405-4412
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Country | US
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Telephone | 912-355-0122
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Fax | 912-355-6620
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Provider Business Mailing Address
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Address Line | 106 BRECKENRIDGE DR
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City | SPRINGFIELD
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State | GA
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Zip | 31329-4226
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Country | US
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Telephone | 912-754-6162
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 016920
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License Number State | GA
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