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General NPI Number Information
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NPI Number | 1447240510
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Entity Type | Individual
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Provider Name | SAMUEL L. FEATHERSTON MD
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Gender | Male
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1707 MEADOWS LN STE G
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City | VIDALIA
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State | GA
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Zip | 30474-7201
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Country | US
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Telephone | 912-535-5120
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Fax | 912-535-2015
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Provider Business Mailing Address
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Address Line | 1707 MEADOWS LN STE G
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City | VIDALIA
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State | GA
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Zip | 30474-7201
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Country | US
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Telephone | 912-535-5120
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Fax | 912-535-2015
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME119873
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 055045
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License Number State | GA
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