Provider Demographics
NPI:1689843641
Name:KAREN L FEHR DALESSANDROMDPC
Entity Type:Organization
Organization Name:KAREN L FEHR DALESSANDROMDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FEHR DALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-692-1080
Mailing Address - Street 1:5354 REYNOLDS ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6007
Mailing Address - Country:US
Mailing Address - Phone:912-692-1080
Mailing Address - Fax:912-691-0551
Practice Address - Street 1:5354 REYNOLDS ST
Practice Address - Street 2:SUITE 222
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6007
Practice Address - Country:US
Practice Address - Phone:912-692-1080
Practice Address - Fax:912-691-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BDTPSMedicare Oscar/Certification
GRP6159Medicare PIN
GAX98230Medicare UPIN