Provider Demographics
NPI:1033795059
Name:PRATHER, FELICIA (MD)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:PRATHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 JOSEPH E BOONE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-2765
Mailing Address - Country:US
Mailing Address - Phone:678-881-7695
Mailing Address - Fax:
Practice Address - Street 1:962 JOSEPH E BOONE BLVD NW # 13
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2765
Practice Address - Country:US
Practice Address - Phone:678-881-7695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 1041S0200X, 103TP0016X
GA103TS0200X, 171M00000X, 172A00000X, 173000000X
GA1167203207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No173000000XOther Service ProvidersLegal Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA053043082OtherFAMILY MEDICINE