Provider Demographics
NPI:1598742405
Name:FEEMAN, MARK WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:FEEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ATLANTA HWY STE 904
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1252
Mailing Address - Country:US
Mailing Address - Phone:404-659-5909
Mailing Address - Fax:770-399-9449
Practice Address - Street 1:2785 LAWRENCEVILLE HWY STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2515
Practice Address - Country:US
Practice Address - Phone:404-659-5909
Practice Address - Fax:770-399-9449
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028767208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00400793AMedicaid
25BDBHMMedicare ID - Type Unspecified
GA00400793AMedicaid