Provider Demographics
NPI:1356738827
Name:SYDNEY FELKER-ROSS, PH.D. LLC
Entity type:Organization
Organization Name:SYDNEY FELKER-ROSS, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELKER-ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-254-7194
Mailing Address - Street 1:1150 S MILLEDGE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-6723
Mailing Address - Country:US
Mailing Address - Phone:706-254-7194
Mailing Address - Fax:706-955-6858
Practice Address - Street 1:1150 S MILLEDGE AVE STE 3
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-6723
Practice Address - Country:US
Practice Address - Phone:706-254-7194
Practice Address - Fax:706-955-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I645271Medicare PIN