Provider Demographics
NPI:1891883179
Name:FELTY, KEVIN P (SA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:P
Last Name:FELTY
Suffix:
Gender:M
Credentials:SA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 422444
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30291
Mailing Address - Country:US
Mailing Address - Phone:678-566-2780
Mailing Address - Fax:678-566-2785
Practice Address - Street 1:8737 DUNWOODY PLACE
Practice Address - Street 2:SUITE 4
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350
Practice Address - Country:US
Practice Address - Phone:678-566-2780
Practice Address - Fax:678-566-2785
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA2356363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical