Provider Demographics
NPI:1982756599
Name:FEELY, THEODORE STEVENS (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:STEVENS
Last Name:FEELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 WEST LAKESHORE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-226-5900
Mailing Address - Fax:205-226-5937
Practice Address - Street 1:817 PRINCETON AVENUE SW
Practice Address - Street 2:PROFESSIONAL OFFICE BLDG II, SUITE 206
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211
Practice Address - Country:US
Practice Address - Phone:205-226-5900
Practice Address - Fax:205-226-5937
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500182207R00000X
GA060832207R00000X, 207RN0300X
ALMD.34508208M00000X
AL34508207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1241808OtherAMERIGROUP
GA52260873 001OtherBCBS - GA
GAP00649787OtherMEDICARE - RAILROAD
GAN460702OtherWELLCARE
GA196561329AMedicaid
GAP00649787OtherMEDICARE - RAILROAD
GAN460702OtherWELLCARE