Provider Demographics
NPI:1245360577
Name:ROY, FELICIA MICHELE (EARLY INTERVENTION)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:MICHELE
Last Name:ROY
Suffix:
Gender:F
Credentials:EARLY INTERVENTION
Other - Prefix:MRS
Other - First Name:FELICIA
Other - Middle Name:MICHELE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3376 COOPER BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2321
Mailing Address - Country:US
Mailing Address - Phone:706-536-1917
Mailing Address - Fax:
Practice Address - Street 1:3376 COOPER BRANCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2321
Practice Address - Country:US
Practice Address - Phone:706-536-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator