Provider Demographics
NPI:1083812432
Name:FELKER, FORT FRASER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FORT
Middle Name:FRASER
Last Name:FELKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 PIEDMONT ROAD N.E.
Mailing Address - Street 2:SUITE 12K
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1551
Mailing Address - Country:US
Mailing Address - Phone:404-814-9242
Mailing Address - Fax:
Practice Address - Street 1:3530 PIEDMONT RD N.E.
Practice Address - Street 2:SUITE 12K
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1551
Practice Address - Country:US
Practice Address - Phone:404-814-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6898208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF10530Medicare UPIN