Provider Demographics
NPI:1114091469
Name:FEDOVSKIY, KANEY JERVELLE (MD)
Entity Type:Individual
Prefix:
First Name:KANEY
Middle Name:JERVELLE
Last Name:FEDOVSKIY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KANEY
Other - Middle Name:JERVELLE
Other - Last Name:CRUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:170 BOULEVARD SE
Mailing Address - Street 2:APT #E122
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2325
Mailing Address - Country:US
Mailing Address - Phone:404-441-0477
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:#26024
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-6689
Practice Address - Fax:404-616-0207
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0547102084P0800X
CAA970052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry