Provider Demographics
NPI:1659516367
Name:FECKOURY, DANIEL MICHAEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:FECKOURY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 PACES FERRY RD SE STE 1-1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6151
Mailing Address - Country:US
Mailing Address - Phone:770-486-5000
Mailing Address - Fax:
Practice Address - Street 1:706 DIXIE ST STE 350
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3860
Practice Address - Country:US
Practice Address - Phone:770-812-5831
Practice Address - Fax:770-812-5832
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA080953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine