Provider Demographics
NPI:1245697648
Name:FEEMAN, PERRY
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:FEEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GLENRIDGE POINT PKWY NE
Mailing Address - Street 2:UNIT 1216
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:917-439-7176
Mailing Address - Fax:
Practice Address - Street 1:111 GLENRDG PT PKWY NE
Practice Address - Street 2:1216
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1478
Practice Address - Country:US
Practice Address - Phone:917-439-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist