Provider Demographics
NPI:1609858976
Name:PIERRE, FELICIA D (DPM)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:D
Last Name:PIERRE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:FELICIA
Other - Middle Name:DIANE
Other - Last Name:DICKSON-PIERRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:4500 HUGH HOWELL RD STE 730
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4738
Mailing Address - Country:US
Mailing Address - Phone:470-207-0700
Mailing Address - Fax:470-207-0702
Practice Address - Street 1:4500 HUGH HOWELL RD STE 730
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4738
Practice Address - Country:US
Practice Address - Phone:470-207-0700
Practice Address - Fax:470-207-0702
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000853213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000802282AMedicaid
GA000802282AMedicaid
GA480026113Medicare PIN
GAU70725Medicare UPIN
GA48SCBXRMedicare PIN