Provider Demographics
NPI:1497172639
Name:GARY, FELICA
Entity Type:Individual
Prefix:
First Name:FELICA
Middle Name:
Last Name:GARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FELICA
Other - Middle Name:
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2561 PYE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31903-3610
Mailing Address - Country:US
Mailing Address - Phone:706-442-5341
Mailing Address - Fax:706-221-5936
Practice Address - Street 1:2561 PYE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31903-3610
Practice Address - Country:US
Practice Address - Phone:706-442-5341
Practice Address - Fax:706-221-5936
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker