Provider Demographics
NPI:1427183722
Name:FELLER, JOSEPH H (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:FELLER
Suffix:
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:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:901-226-3172
Mailing Address - Fax:901-226-3191
Practice Address - Street 1:100 HOSPITAL STREET, STE. 100A
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829
Practice Address - Country:US
Practice Address - Phone:662-720-3035
Practice Address - Fax:662-720-3066
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018247208600000X
MS21966208600000X
WI70563208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery