MEDICARE: GREGORY SHAWN FELZIEN M.D.

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	207R00000X	Internal Medicine Physician	23900	OK

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	202I445780	OTHER	GA	PTAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811971625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY SHAWN FELZIEN M.D.

Provider Business Mailing Address
First Line	:	3 WEST ALTMAN STREET
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-5212
Country	:	US
Telephone Number	:	912-764-2402
Fax Number	:	912-764-5561

Provider Business Practice Location Address
First Line	:	3 WEST ALTMAN STREET
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-5212
Country	:	US
Telephone Number	:	912-764-2402
Fax Number	:	912-764-5561

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	03/14/2012

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