Provider Demographics
NPI:1124184734
Name:FELLOWS, STEVEN ARNOLD (MA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ARNOLD
Last Name:FELLOWS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:1825 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1625
Practice Address - Country:US
Practice Address - Phone:706-295-5331
Practice Address - Fax:706-238-8072
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD000001231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000329744BMedicaid
GA000329744CMedicaid
GA000329744FMedicaid
GA000329744GMedicaid
GA000329744EMedicaid
GA000329744DMedicaid
R70778Medicare UPIN
GA64PCBGRMedicare ID - Type UnspecifiedCALHOUN
GA000329744BMedicaid