Provider Demographics
NPI:1922282557
Name:PELAEZ, FELIX (MD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:PELAEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 UPPER RIVERDALE RD SW
Mailing Address - Street 2:#B
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2565
Mailing Address - Country:US
Mailing Address - Phone:770-991-2289
Mailing Address - Fax:770-991-1345
Practice Address - Street 1:195 UPPER RIVERDALE RD SW
Practice Address - Street 2:#B
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2565
Practice Address - Country:US
Practice Address - Phone:770-991-2289
Practice Address - Fax:770-991-1345
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA024172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00347421AMedicaid