Provider Demographics
NPI:1831554120
Name:FELIX PELAEZ MD
Entity type:Organization
Organization Name:FELIX PELAEZ MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-991-2289
Mailing Address - Street 1:195 UPPER RIVERDALE RD SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2518
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:SUITE B
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2518
Practice Address - Country:US
Practice Address - Phone:770-991-2289
Practice Address - Fax:770-991-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty