MEDICARE: FELICIA PRATHER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	103TS0200X	School Psychologist		GA
3	1041S0200X	School Social Worker
4	171M00000X	Case Manager/Care Coordinator		GA
5	172A00000X	Driver		GA
6	173000000X	Legal Medicine		GA
7	207QA0401X	Addiction Medicine (Family Medicine) Physician	1167203	GA
8	103TP0016X	Prescribing (Medical) Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	053043082	OTHER	GA	FAMILY MEDICINE

General Provider Information

NPI Number	:	1033795059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA PRATHER MD

Provider Business Mailing Address
First Line	:	962 JOSEPH E BOONE BLVD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-2765
Country	:	US
Telephone Number	:	678-881-7695
Fax Number	:

Provider Business Practice Location Address
First Line	:	962 JOSEPH E BOONE BLVD NW # 13
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-2765
Country	:	US
Telephone Number	:	678-881-7695
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2021
Last Update Date	:	03/21/2021

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Directions to “ FELICIA PRATHER MD” Practice Location

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