MEDICARE: MARK WILLIAM FEEMAN D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	028767	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598742405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WILLIAM FEEMAN D.O.

Provider Business Mailing Address
First Line	:	2450 ATLANTA HWY STE 904
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-1252
Country	:	US
Telephone Number	:	404-659-5909
Fax Number	:	770-399-9449

Provider Business Practice Location Address
First Line	:	2785 LAWRENCEVILLE HWY STE 100
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-2515
Country	:	US
Telephone Number	:	404-659-5909
Fax Number	:	770-399-9449

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	03/01/2024

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